Back pain is a very common complaint among people of all age groups. It is, however, more commonplace among people in their thirties and onwards, but is not unfamiliar to those younger due to the increasing demand to sit (sedentary lifestyle).
Back pain is mostly due to degenerative (wear and tear) changes in the spine and is usually part of a progressive degenerative disease. Thus, the underlying problem responsible for back pain will slowly but surely worsen over time. So how is it that people who are so young can have a condition related to degeneration? Well it has got a lot to do with the amount of time we spend sitting. Many of the spinal structures such as the intervertebral disc, which act like shock absorbers and the ligaments that hold the spine together need to be very elastic for them to do their job and as a result have evolved to survive with a very sparse blood supply. The stretching and relaxation and the loading and unloading of these structures cause nutrients and oxygen to be sucked in and waste products pumped out. So as we tend to be more stationary at work i.e. sitting all day, have entertainment that require sitting and sitting to travel to all our destinations, these structures no longer get their needs met and hence undergo degenerative changes, not to mention that sitting for periods causes weakening of the supportive structure muscles of the spine.
Mechanical back pain –
Mechanical back pain is the kind of back pain that comes when doing normal things; bending to make the bed, picking a pen off the floor, serving a tennis ball, weeding in the garden, etc. These are actions that we shouldn’t get injured doing.
Overtime, either due to postural stresses or past injury we develop fibrous reinforcement through our soft connective tissue of the spine (muscles, ligaments, disc, joint capsule, etc). This reinforcing tissue is strong but not very elastic and interferes with the way the spine moves and can render the spine vulnerable during normal everyday activities. The spinal structures become strained when they can not stretch or cope with the loads they need to endure. Subsequently, an altered movement pattern arises as the joints involved lose mobility and surrounding joints compensate by taking on their load to produce the overall movement required. Depending on how long it takes to be addressed, the altered movement patterns of the joints involved undergo degenerative changes.
Referred back pain –
This is pain that spreads from the inflamed tissue in the lower back along nerves to other parts of the body. This would frequently be experienced in the area of the hips, thighs and gluteals region. This is directly associated with mechanical back pain. It should not be confused with sciatica. The patterns of referred pain frequently overlap somewhat with sciatica, but there should be no confusion between the two.
Sciatica (Radicular pain) –
This is pain that is caused by a pinched nerve and the pain will travel down the length of the nerve and be most severe at the distal point of the nerve, but can manifest at any point along the length of the nerve. When the nerve, for instance between the fourth vertebra and the fifth vertebra, is being ‘pinched’, the pain will be sensed at the ankle and on the top of the foot, as this is where the nerve ends up. It is typical that referred pain spreads to the upper leg, but sciatica would normally spread beyond the knee. When there is compression of this nerve root, you will experience pain over the area supplied by that nerve which may be present as a sharp-shooting electric pain with associated numbness, tingling and/or weakness. Both the physical compression of the nerve root and the inflammatory changes in and around the nerve root are responsible for the pain.
Treatment at George St Chiropractic is aimed at restoring the back movements so that the soft tissues and joints of the back can move freely and cope with normal activity without getting distressed so that tissues can repair as soon as possible.
When the spinal structures are injured or inflamed, swelling occurs in and around the tissues and painful chemicals build up. It is important that these fluids can be drained, while oxygen and nutrients can be supplied to the area to facilitate the healing process.
We massage and loosen the tight structures that are involved so that we can gently and safely restore movement. As mentioned above, it is movement that enhances the supply and drainage to the spinal structures. The methods of loosening joints are decided by you after discussing options with your chiropractor. Spinal manipulation in the form of gentle adjustments may be offered or alternatively a specialised mobilisation may be used. Some people have contraindications or may be fearful of manipulation so for these people the mobilisation technique is a great choice.
In the case of disc herniation a manual distraction of the vertebrae is usually used to retract the disc bulge and create more space for the spinal nerves involved. When a disc herniation is acute spinal manipulation is contraindicated (according the WHO) so the facet distraction is a great alternative without the same risk factors and is extremely effective.
Our Chiropractors at George St Chiropractic always take a detailed history and thorough physical examination. If you have any previous imaging like X-ray, CT or MRI, it is important for us to see them and sometimes more current imaging may be requested in our assessment, which Dr. Steve Crome and Dr. Jack Sahagian can arrange. We also place a big emphasis to limit any manipulation to an extremely gentle force. We then advise the patient on postural tips and preventative exercises included.
Helping those in the Sydney CBD and surrounding areas is our top priority.