Back Pain Treatment in London & The South

Probably the most common question ever asked, and probably the most difficult answer for a patient to hear is “well, it’s complicated….” I think we can do better than that for most, not all, people. Think along the 80/20 principle and there are a few rules, though.

First up, this is about gradual, insidious back pain in someone who does a bit of exercise, not dramatically overweight, with no medical nasties and older than 20 but younger than 70.

Here we go…something that moves too much, without enough control will start to hurt. Just wiggle your finger back and forward, a lot and right to the end of range – don’t control where it starts or where it ends. It’ll soon start to hurt. To make it feel better – and this won’t happen overnight, you need to rest the finger, but you can move the wrist instead so the finger still moves back and forward. So the range of motion is about the same but it’s happening at the wrist and not the finger.

Often painful joints have too much joint play because other bits of the body don’t move enough, hence the finger story and with back pain very commonly it’s about having a really stiff thoracic spine, which is compensated for by making your lumbar spine move more. Your range of motion may not change that much, but where you move, does.

Most people have a stiff thoracic spine – no big deal, but if your low lumbar spine has more relative movement, without control, then your back will hurt. If you drift your mind back to the finger analogy and actually start to gently control the wiggle by making your muscles work around your finger, you control the range and start to move your wrist to keep the same range of motion…..exactly (kinda) the same thing happens with your back. So, stop stretching your back and start mobilising your thoracic spine and control your lumbar spine motion by using your glutes. It really can be that simple for some….

This depends on if you wake up because of back pain, or move and your back hurts.

If it’s the former try to avoid sleeping on your stomach or try sleeping with a pillow between your thighs. This keeps your knees apart and stops them rolling in, which couples with gently sticking your bottom out and (maybe) compressing the low back. The best effect is enough pillow to keep your knees and hips in a horizontal line, maybe works better for females (hips!) but it is a real pain to keep stuffing pillows down there. Only use this as a last resort or very temporary measure, but ramp up your glutes….which helps control the rolling in and actually gets to roll your thighs out.

If on the other hand it’s the movement that wakes you then make sure you do whatever you can do to mobilise your thoracic spine before you leap into bed at night, and maybe take some anti inflams (only if you can) before you snooze.

Well, there is feeling better or getting better. If you want to feel better then go for your life and stretch whatever feels tight and painful BUT don’t get too miserable if this makes your pain worse tomorrow or you have to do this every. single. day. Why? Because it doesn’t help the cause of your symptoms, it just makes you feel better. Also don’t forget over the counter anti inflammatories and painkillers (only if you are allowed to take) are sometimes brilliant at helping with back pain relief. They are not the be all and end all, but certainly should be part of your artillery – just as hot baths, going for a walk, being mindful, doing some exercise are all great too. Our personal favourite is lying lengthways on a foam roller, feet on the floor – knees bend and head on the roller for 10 whole minutes. Don’t knock it, till you’ve tried it.

This can be two separate things, or a singular thing. The pain is normally due to something doing too much and “failing”. The numbness is likely to be compression of a nerve either due to a disc pushing on the nerve or inflammation surrounding the nerve. If you think the numbness is getting worse or you are getting progressively weaker (tripping etc) or even having problems with having sex, going to loo or losing sensation “down there” then go get help sooner rather than later.

Pain, can be really complex, not all the time but certainly sometimes and may have nothing to do with bones or muscles or discs or nerves but simply (!) your own body interpreting a normal sensation erroneously. A little like a paper cut – it feels like you’ve chopped your finger off, until you realise it’s a tiny nick. Your thoughts, emotions, sleep patterns etc all play into this and should absolutely be recognised.

This is when the straw has finally broken the camel’s back and things have gone pop. This can be quick – sneezing, tripping, (sometimes..see next bit) lifting or bending. Or it can be slow – whilst you might experience pain when lifting or bending it’s probably just the end of the line when something was going to happen anyway and this is what you perceive as being the issue. Or something as simple as getting out of a chair or getting up in the morning…it was going to happen.

The exact, precise anatomical structure that is causing the pain is pretty hard to pinpoint, even with an MRI. But 80%+ of normal back pain is most likely to be attributed to an L5/S1 disc or L4/5 facet joint – sounds very impressive and if in doubt these diagnoses are very, very common…but doesn’t necessarily mean this is where the pain is coming from! Probably lots of pain also comes from the protective muscle spasm that is trying to prevent further damage. Spasm, whilst being very painful is actually a pretty good thing to have as it is trying to kick start the healing process and preserve your tissue.

Let it hang around for 48/72 hours – your body will thank you in the long run, but not immediately, and so things like Tramadol does have a very small (but important) role in acute low back pain.

Initially stick with the over the counter NSAIDS anti inflammatories (Ibuprofen) and pain killers (Paracetamol) if you’ve been given the OK to take them. You can be prescribed stronger anti inflams (Voltarol, Sodium Diclofenac, Naproxen etc) and painkillers (Co-codamol etc) and even muscle relaxants (Tramadol). There are also clever pain blocking medications like Gabapentin or pregabalin (Lyrica). These are generally prescribed by pain specialists.

Absolutely, yes. Plenty of studies support this notion and should be discussed with any person looking after you. Not only does anxiety inhibit but also encourages plenty of hormones that really alter the pain signals to and from the brain which magnify the symptoms you feel…same thing with poor sleep pattern, lack of exercise, mental wellness issues.

Fantastic. But if you’ve got back pain and you cycle, try doing something different for a while to allow your back a breather. Do something that’s going to help reverse the static posture of being slumped over handlebars for possibly hours and hours. And if you cycle that much then do make sure you’ve got your rig is well set up. Headset, stem, crank arm, bike size etc all need to be optimised for your body size and shape

Fantastic – it’s kind of a carbon neutral activity. It’ll make you feel better but won’t (probably) cure back pain – but it does allow you to exercise and do something. Probably breaststroke isn’t the best stroke when your back is sore due to the position you get into when swimming, but pottering up and down for a few lengths (rather than smashing out km after km) won’t hurt anybody.

No, nope and no. Exercise is great for most things, pretty much all the time BUT if it hurts, say more than 3/10 pain then dial it down. Everyone was told that running is bad for knees, research and anecdotal evidence begs to differ, as long as it’s pain free then it’s good to go. Possibly controlled based exercise ie Pilates is initially better when recovering from low back pain, but a combo of control, strength and flexibility will always save the day.

Pretty much the same as men, but pelvic pain in women is more common – not to say Men can’t (and do) suffer from pelvic pain. Women do have different anatomy and so things like period pain, endometriosis, ovarian cysts and pregnancy pains are part of the female domain.

This is the $1000 question- who should you see for low back pain?

This is often pretty confusing especially as lots of practices have all 3 disciplines working together. Despite us all aiming for the same point, our clinical reasoning can be pretty different. We all want the best for our patients and so (try to!) take an unbiased view despite being pro Physio.

The vast majority of peer reviewed and accepted research in mainstream physical medicine has been Physio lead and so very much part of our DNA.