Back Pain: When To Seek Help

Statistics 

Lower back pain is the largest single cause of disability in the UK, approximating 11% of those defined as disabled within the UK. There is approximately £200 million spent on spinal surgery by the National Health Service (NHS) each year, with over 10,000 elective spinal surgeries. An independent review from the UK Spine Societies Board (UKSBB) concluded that “The current pathway of management for low back pain is not planned, has little reference to the evidence base and contains very significant delays at every step”.  At the time of writing this article, "Back Pain" is ranked in the top 7% of all google searches in the UK. 

 

Common Pathologies 

Back Pain can present in many different forms and cause a variety of symptoms. This is by no way an exhaustive list, but we've comprised the most common we treat in clinic;

1| Bio-mechanical 

Can also be called; non-descript, un-diagnosed or postural back pain. Generally, this doesn't involve a mechanism on injury- the pain tends to come on insidiously over time. It can be linked to changes in lifestyle. For example; a new bed, a new car, a new desk, a new exercise routine, cessation of exercise , pregnancy, weight gain etc. 

Pain Pattern - Haphazard (Potentially linked to activity)

2| "Slipped" Disc 

This is the umbrella term for a compromised disc. There are many different variations of compromised discs as seen below. Your discs are a fluid filled structures that sit between the individual segments of the spine and are designed to absorb impact. Through injury or degeneration, problems can occur leading to back pain.

Pain Pattern - Flexion (Bending Forward) & Compression (Prolonged sitting or standing) 

 

3| Facet Joint Sprain 

The facet joints provide another area of contact between two vertebra throughout the back. Generally Facet joints are injured through trauma such as repetitive strain , heavy lifting and direct impact. 

Pain Pattern - Extension (Bending Backwards) & Rotation (Twisting) 

4|Stress Fracture 

Stress Fracture can occur throughout the body. Most commonly in the feet, legs and lower back. As the name suggests the bone fractures due to the repetitive stress its being put under. Stress fractures of the lower back most commonly occur in Athletes that jump a lot such as Basketballers. 

Pain Pattern - Sharp Pain on Impact, Pain on Extension (Bending Backwards) 

When to Seek Medical Assistance 

Even with the information above, it can be extremely difficult to interpret your pain and decide when, if at all, to get a medical professionals opinion. Below we've highlighted the key considerations when making that choice. 

Chronic Pain| This is generally defined as pain that has been present for 12 weeks or more. At this stage, tissues that were going to heal naturally should have. This could indicate a serious underlying pathology or just that your self management was inadequate. 

Neurological Symptoms| By this, we mean referred pain into the buttock, groin or leg. This is indicative of nerve entrapment somewhere within the multiple exits of the spinal cord. Often early intervention whether surgical or conservative yield quicker recovery. 

Yellow Flags| This is a point that's often very difficult to approach with patients. Yellow flags are warnings from the patient that something is wrong psychologically or socially. For example; your back pain is causing mood swings, absences from work or relationship trouble. Often these patients require conventional rehabilitation + behavioural therapy techniques. 

Red Flags| These are the medical alarm bells. If we hear a patient mention these symptoms we tend to send them on for immediate medical attention. For example, Bilateral referred leg pain, loss of bladder or bowel control,  extreme weight loss, night pain & sweats. These symptoms may suggest serious spinal cord injury or cancer and need immediate investigation. 

 

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