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Back Pain, a Reflection

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Written by Mindi Cotton | Posted on January 9, 2019

Lower Back Pain

Lower back pain can be quite scary, especially if it is sharp or if there doesn’t seem to be any reason for it to have started. There are many small structures that can be affected and become painful, and with the low back in the centre of your body, it can be influenced by many different areas, from the position of the head all the way to how your ankles are moving. It can be dull or sharp, focal or radiating up and down the spine and buttocks, movement can aggravate it or relieve it, each patient is different.

So how does the back work?

Your lower back is formed of a column of 5 lumbar vertebrae stacked up one on top of the other. This column of bone has to bear the weight of your entire thorax, arms and head, as well as absorb and translate forces coming from the ground through the legs. There are a few elements needed to make sure this column of bone behaves normally:
work needs to be evenly distributed across all 5 segments — if one segment has to do all the work because the other ones aren’t moving as well as they could, it may strain it needs a stable base — if the pelvis is lopsided or moving in an odd way, the lower back may have to compensate for it the muscles around it need to be strong to stabilise it — the core muscles include the buttocks, the “lats“ and the muscles around the abdomen, acting like a corset, or guy ropes around a mast. Your centre of gravity needs to fall in the right place — too far forward and the muscles of the back will have to work harder, too far back and you may need to “drop“ through the low back and compress the spine into a backward arch.

What’s the structure that hurts?

There are roughly 21 joints in the lower back and about 24 main muscles that can pull it in any directions (depending on which textbook you look at). That’s without counting all the tiny muscles between every single vertebrae (that’s roughly another 34) and as many ligaments and tendons holding everything together. Add an extra disc between each vertebrae, a few nerves, the whole lot wrapped in sheets of connective tissue and you have well over 100 different structures that can become painful. Every structure has its role to play and is highly integrated with its environment. They may become painful when stretched (eg. a ligament), when compressed (eg. a joint) or when moving (eg. a muscle) Some have a very good nerve supply (they will be extremely painful very quickly) when others don’t (they may take a while to get irritated and produce a duller ache) so there can be many different manifestations of lower back pain.

When should I seek help?

We all get aches and pains every now and then, so when is it ok to let it get better on its own? Sometimes it’s tricky to tell when one should seek help. My advice is that if your lower back pain doesn’t start to improve about 3 days after the initial onset, if your symptoms seem to be getting worse rather than better or if the same problem keeps happening over and over again in the same place, it is probably a good idea to seek professional help. We can tailor our approach to your current state: if the pain is very acute, there are a lot of very gentle techniques we can use to calm the tissues down, before addressing the cause in the background. If the pain is almost gone but you know it keeps happening in the same place and you don’t want it to come back, we can examine the surrounding tissues for clues as to why it keeps happening.

What is my Osteopath going to do?

The Osteopath’s first job is to identify the cause of the problem. Which structure is causing the pain, but most importantly, why did it start in the first place or why is it failing to get better? We will look at your overall posture, see how your spine, pelvis and legs are moving by asking you to do a few simple movements, and we have simple tests that we can use to check different structures (we may ask you to stand on one leg or gently lift your leg up whilst you lie on your back). We may also check your reflexes and muscle power. Once we understand more about what is going on, then we can work out a way forward — this will likely include manual therapy to normalise range of motion in different joints and muscle tone. Treatment may not be isolated to the lower back. We may find that the way your ankle moves is producing a twist through the leg that in turn is upsetting the lower back, or we may find that you are holding your head forward, thus throwing your centre of gravity off balance. I also like to include lifestyle advice to my treatment — I often give tips on desk setup and posture. I like to talk about activities one can do to strengthen and mobilise the back, be it swimming, yoga, pilates or other. There are often a few simple exercises I can give patients to speed up their recovery and prevent the problem from coming back. I think educating patients and making them aware of what is going on is a key element of my practice — once you know what is going on, you have the tools to decide how you wish to go forward.

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