Some of the most common reasons for presenting to my practice include lower back pain and sciatica. These are problems which cause a great deal of worry for some, but for the majority acute low back pain is transient, self-limiting and does not, as many believe, lead to a life time of back problems.
Whilst most people may be aware of how to avoid back pain, people are less aware of first-aid for backs, and what the future holds after an injury. I shall try to enlighten readers and clear up a couple of myths.
Firstly, a quick anatomy lesson. The spine is constructed from a series of bones called vertebrae, stacked on top of one another to form a column which extends from the base of the skull to the bottom of the back. There are 24 vertebrae, each one is firmly secured to its neighbor by several small muscles and strong ligaments. In between each vertebrae there is a disc. The inter-vertebral disc is made of a tough sinewy material with a softer jelly-like core. The disc is very firmly bound to the vertebrae.
One common misconception is that the disc can slip out of place and consequently can be manipulated back in. Given its very strong attachments, this is not possible. A disc injury usually involves some of the outer fibres becoming frayed and weakened which allows the softer center to bulge outward to some extent. The damaged tissue then becomes swollen and inflamed, which is a normal part of tissue repair. Inflammation is an inherently painful process which causes pain at or near the site of injury, and the swelling is sometimes sufficient to irritate the nerve roots which originate from the spinal cord nearby. These nerves supply the leg which is why pain can be felt in the thigh and calf.
Rarely, a healthy disc can be injured by a sudden trauma such as a very heavy fall, or through trying to lift something extremely heavy. Much more commonly, the disc is weakened little by little over months or years by minor repetitive irritation such as sitting all day on poor seating, or through excessive bending and lifting. This gives rise to low grade, intermittent back ache which most people ignore, until their back goes, and they are forced to hobble into my practice! Whilst disc injuries can, in most cases be successfully treated osteopathically, prevention is of course better than cure, which is why it really is important to ensure that seating at work is appropriate, and that those with manual jobs educate themselves about posture and how to lift correctly. Seeking professional advice before the pain gets worse is also worthwhile.
Other tissues in the spine which can become injured include the ligaments, muscles and joints. Like a disc injury, this can result from a sudden trauma or develop over time. Also like a disc injury, the associated swelling and inflammation can cause referred pain into the leg. This kind of referred pain is often termed sciatica. Unfortunately, this popular term means nothing more than pain down the back of the leg. It is not a diagnosis, and gives no clue as to the origin or prognosis since, as we have seen, it can result from injury to a number of spinal structures. Nor does it mean there is anything wrong with the sciatic nerve. An osteopath will in most cases be able to identify what is causing the sciatica and treat accordingly.
So what should you do if you have just hurt your back? Firstly, dont panic. Remember that most back pain results from fairly uncomplicated sprains or strains, and will get better quickly. If the pain is fairly minor, carry on as normal but in the short term avoid specific movements which are painful. Movement stimulates tissue healing, so walking for at least 30 minutes a day will often help. For more severe pain which stops you from doing your normal work, getting treatment really is the best option. Until you can get seen, try to find a comfortable position, perhaps on your side with your knees up a little, and put a cold pack on the painful area for about 8-10 minutes. A bag of frozen peas in a tea towel will do, repeat every hour. Movement is still beneficial, anything from gently rocking your torso about whilst lying down, to short walks if you can manage it. From then on, controlled return to normal activity as you recover will be possible. In any case, seek advice if your symptoms do not improve significantly in a week or so. A qualified osteopath can speed recovery of most back injuries, advise about posture and lifting technique, and teach exercises which will help you return to sport and normal activity.