Understanding and Solving Lower Back Pain

back pain and joint pain
aching joints and back pain

On this page I cover what I consider to be the important aspects of back pain to lots of men and women. From the causes of your pain through what is happening on the inside of your spine to the stages of recovery and how they relate to successful rehabilitation. You will find it both enlightening and refreshingly helpful.

INTRODUCTION

Back and joint pain is without doubt one of the scourges of the twentieth and twenty-first centuries. It is one of the commonest medical complaints in The Western World. It can be completely disabling and thoroughly depressing. It affects millions of us and yet appears to have no exact and definite scientific cure. Amazing when you consider that we can put people on the moon.

What’s the knock on effects? Several, from mild to serious and severe back pain, swelling, tenderness as well as occasional, recurrent or persistent pain, cramps. Just ask anyone who suffers from it. You struggle to get to sleep and wake up regularly during the night. In the morning you can hardly get out of bed.You can’t bend to get dressed properly and it hurts to do the simplest things. Working is painful and often out of the question. You cannot sit or drive for any time.and exercise is simply out of the question.

A long list of life destroying patterns from one simple complaint that medical science seems to be unable to effectively solve.

Aching Back pains are not disorders which has one single cause. There are numerous possible reasons why you may have back pain. There are also differing schools of thought from the many varieties of practitioners in existence who all claim to be able to solve your problem. Chiropractors, osteopaths, manipulators, masseurs, reflexologists, herbalists, acupuncturists to name just a few without mentioning the surgeons and back pain specialists. The list goes on. Can they all be right?

Generally, in my experience, people fall into one of three categories regarding the causes of their back pain, explained as follows:

1. There has been no specific onset or particular injury. The pain just seems to have crept up and hurt you.

2. There have been numerous, relatively minor or even innocuous incidents that seem to be responsible for your pain.

3. There is a definite incident that coincides with the start of your problems.

The cause of such stresses may be:

• Postural i.e. the way you hold yourself and how you sit and stand.

• Occupational i.e. related to the activities you do at work.

• Recreational i.e. caused by your sporting or hobby activities.

INFLAMMATION

One of the keys to understanding back pain is understanding a little about inflammation. This phenomenal process is nature’s way of responding to damage to the body. It is essential to maintain life. If it did not occur in a short time you would die. It is nature’s way of preventing further injury and repairing any damage that has already occurred.

Explaining it as simply as possible what happens is that around the site of the injury blood flow is increased. This causes certain type of blood cells to be forced out of the blood vessels into the damaged area to begin the healing process.

Chemicals from the injured structures cause irritation to the nerve endings in the area, which then send messages to your brain that your brain interprets as aches and pain. This is to tell you that there is something off and to encourage you to protect the damaged area so as to avoid pains. The increased blood flow, the irritated nerve endings and the start of the healing process cause the area near to be warm, swollen and painful.

It will stay like this for around two or three days. This can vary depending on the degree of trauma to the body part in question. This stage is often termed the acute stage and is essentially concerned with damage limitation and stabilization to ensure no further damage occurs.

Following on from the first two or three days the process of structural repair begins in earnest. Your body will attempt to replace and reconstruct the injured area. The length of time this takes varies with many factors. Amongst these are age, general health, any predisposing medical conditions, the amount of damage that has occurred and how the body part is treated during this time.

During the repair process damaged structures will be repaired in one of two ways. If the damage is only minor the repair will be made with the exact same type of tissue as the original. If the damage is greater then the repair will be made with what is called scar tissue. This is a tough inelastic substance the body uses to rapidly rebuild damaged areas. Damage does not have to be that great for scar tissue to be used.

Once the healing is complete the repair process stops. It is important to note though that healing can continue for many months after an injury, albeit at a very low level, even though normal functional activities have been resumed.

THE STAGES OF HEALING

The process follows a really general pattern as follows:

1. The initial acute stage lasting two or three days when there is a symptom of considerable pain, ache and movement restriction.

2. The second or sub acute stage is when the healing process progresses. This lasts for up to three weeks. By this time, if there are no broken bones, the tissues (muscle, ligaments, tendons etc.)have achieved a moderately strong state of repair.

3. This third stage is sometimes called the chronic stage. This is when the repair process has slowed right down. It does not equate with the various healing process being satisfactorily completed however.

Each of these three stages are characterized by alterations in the symptoms you suffer. There are specific ways to treat your sore back at each stage, which is a crucial point to understand and one of the keys in helping to resolve your problem.

THE STAGES OF TREATMENT, REHABILITATION, AND REMEDIES

Assessment and Diagnosis.

The first step is diagnosing what the problem is. This is done by doctors and therapists basically using two methods. The first one being what the patient says or complains of and the second being what is actually found by the practitioner from their physical examination.

Both of these are vital suppliers of information for a correct diagnosis. The sum total of all the information gleaned from both methods should build a picture of the exact problem that leads on to the diagnosis.

Sometimes it is possible to ascertain an exact diagnosis and other times it is not. Having an exact diagnosis is desirable but not absolutely essential to successful treatment.

What is important is that the existence or absence of certain conditions is ascertained so that the correct treatment and advice can be followed.

In the case of back pain it is important to be able to put the cause of the pain down to a mechanical problem affecting the back. With reference to back pain there are certain conditions that give rise to pain in the back and these must be ruled out before treatment should begin.

Pain Resolution

Before movement and activities can be normally resumed there has to be consideration of pain. This is because in the initial stages of an episode of injury the pain is there to prevent further damage occurring. It is important that this pain is respected so that further damage is not caused.

A few days of the CORRECT REST is normally sufficient to achieve this. Longer than this and there are likely to be more negative effects than positive from resting unless a specific reason is given by a qualified medical person. During this period there are treatments that can be helpful in resolving pain such as medication and electrotherapy.

Movement Re-education

The next stage is the regaining of the normal amount of movement in the back. This is the stage at which most problems occur and is normally because people are unsure of the answers to some critical questions as follows:

When to begin moving?

Which specific movements to do?

How many to do?

How often and for how long?

It is here that is so often the KEY CRITICAL POINT in the recovery process because with the CORRECT ADVICE, INSTRUCTION AND ENCOURAGEMENT regarding movement and exercise therapy most back pain can be massively improved.

If this point is missed, problems begin and little by little get bigger and more difficult to resolve until ultimately, if left long enough, which often can be just a matter of weeks, you can become a chronic back pain patient, with all its associated difficulties.

Strength Re-education

The next stage once the movement is well on the way to recovery is the re education of the muscles that control the area. Here again the skill is knowing the answers to such familiar questions as when to begin the exercises, which ones to do, how many and for how long?

You may be lucky and be able to resume your normal everyday activities without needing any specific strengthening exercises. There are however many people with low back pain who would be so much better and be more able with the CORRECT EXERCISE PRESCRIPTION. For some it would undoubtedly totally solve their problem.

Functional Activity Rehabilitation

Following the successful resolution of pain, movement and strength in the previous three stages the final stage is the culmination of all the previous ones to aid the recovery of normal activities. Here again the key is the skillful and correct advice as to how much how soon. If the previous three stages have been addressed properly this stage will follow successfully but the correct advice is still paramount in preventing reinjury.

SUMMARY

So there we have every basic stage behind the successful resolution of mechanical low back pain such as Bilateral foraminal stenosis.Some of which affects limbs such as the legs. This can essentially be transferred to many other musculo-skeletal problems. Although in black and white it appears relatively simple it does not mean it is unskilled. It requires specific knowledge at each of the particular stages.

So when all is said and done is there a magic pill, a cure above all others or a proven way of solving this problem of ours? Well yes actually there does seem to be.

The latest research based on analysis of all the many different ways of treating and dealing with adult back pain indicates that there are definite methods of treatment that produce positive results. It dose not seem to matter what type of professional you visit whether it be an osteopath, chiropractor, physical therapist or any other therapist or healer.

What does seem to matter is that you follow some very simple guidelines that seem to produce very consistent results. These guidelines are simple to follow in your own home and will produce positive results very quickly with some care.

You can have manipulation, exercise, electrotherapy, acupuncture or any other treatment that benefits you but behind all the improvement are some very simple proven principles that you should know about.

These principles are what you need to know so that you can solve your own problem or be helped properly by the practitioner of your choice. They are there to be used alongside and complimentary to any treatment you may be getting from your health professional.

This specific formula is essentially based on simple PROVEN EXERCISES correctly prescribed for your problem. Based on the cause of your back pain you can immediately improve your condition, reduce your pain and increase your pain free movement by following a simple exercise routine in your own home that will take you a few minutes a day.

The concept is based upon where professionally reliable knowledge and know how being used in clinical practice today by thousands of therapists to help achy bone and back pain sufferers solve their problem and improve the quality of their lives.

It is a very brave statement to say that exercise is the key to improving your back and joints no matter what the problem. It is my opinion however that there are very few people with back pain that cannot be improved by the correct prescription of an exercise program that can be done in the comfort of you’re their own home. For some it is the answer and for others a part of it.

The secret is knowing the answers to the questions in the previous sections regarding which exercises must be done, in what way, how many and for how long for a specific problem. Doing blanket exercises for the back is hit and miss and is likely to cause more problems than it solves. I have been prescribing exercises professionally for over two decades and it is undoubtedly a skill to be able to do it well.

In summary what I am saying here is:

· That all the available evidence appears to point to there being a common factor in the successful resolution of back pain.

· That factor is CORRECTLY PRESCRIBED EXERCISE that can be done simply and easily in the comfort of your own home.

It is important to state that these exercises do not deny the existence of the positive effects of treatment by a knowledgeable and skillful practitioner. Just a thought though. Beware of anyone offering you treatment with no form of advice or prescription of exercises. You may wish to ask them why this is so.

Strained Muscles

It feels like pulled muscle or muscle catch? Are you constantly pulling muscles? Well a strained muscle ought to be a simple injury to overcome. This, however, is not always the case. Here we will discuss common muscle strains and how best to treat, care and rehabilitate them. However if you think that you tore a muscle or tendon then you should seek immediate medical assistance. Tears in a muscle can be a serious condition and may require surgery. Look for signs of bleeding under the skin which can signal a ruptured muscle rather than just slight muscular ligamentous strain or sprains.

The Thigh Strain

An overstrained thigh is the name given to any tear of the quadriceps muscle at the front of the upper leg. This muscle is commonly injured because it controls movement at two joints (the hip and the knee) as well as being a major player in the production of power for many sporting and athletic activities.

The most commonly strained muscle of this group is called RECTUS FEMORIS. It is a fairly thin strap like muscle and is often injured by over stretching combined with exertion of the muscle to produce hip flexion with knee extension. This movement is bending of the hip with a knee straightening action as in kicking or sprinting.

A strained muscle such as this is characterized by a sharp pain at the site of injury and pain on attempts at moving the hip backwards or lifting the leg forwards against gravity. Walking can be painful in the first few days after injury.

The Hamstring Strain

So where do we start with this beauty of a strained muscle? Probably the most common soft tissue sporting injury there is. There are not many of us interested in sport who have not witnessed the sudden agony and attempted braking and protective action of a sprinter suffering a breakdown in a hamstring.

 

The hamstring muscle is comprised of three individual muscles that control movement again over the hip and the knee. They are heavily involved in propulsion, thrust and control in athletic movements. Injury will occur when the muscle is asked to contract or shorten too aggressively or when it is in its position of vulnerability i.e. stretched with the hip flexed or bent and the knee extended or straight.

The hamstring muscle has braking role in movement of the knee during running. When you run, your quadriceps at the front of your thigh straighten your knee to get stride length. So that this movement is controlled and your knee does not just ‘snap’ into the straight position the hamstrings contract whilst they are lengthening and the knee is straightening, in order to control the movement of knee extension.

During this activity, known as ECCENTRIC MUSCLE WORK the hamstrings are vulnerable to injury because they are contracting whilst undergoing a stretch or lengthening process. Occasionally the muscle is unable to control the movement and it tears. Result: immediate pain and bleeding in the strained muscle.

The tear can be mild, moderate or severe with anything from a few stretched muscle fibres to a full blown rupture of the muscle. Obviously the amount of bleeding and swelling will vary as will the degree of function loss according to the damage.

The affect on the ability to walk and do normal every day activities with a damaged hamstring is remarkable. The time scale for recovery from a strained muscle of this type can vary from three to twelve weeks, with re-occurrences on attempted return to activity being very common. This is often due to poor advice and/or incomplete rehabilitation.

The Groin Strain

Groin strains need careful attention. They are not as common as the other muscle injuries of the thigh but have the potential to be equally if not more troublesome in certain cases.

Basically there are three muscles that make up THE ADDUCTOR MUSCLE group on the inside of the thigh. They run from the front of the pelvis to the inside of the thigh above the knee. They pull the leg inwards towards the middle and are heavily involved in sporting activities where turning and changes of direction are required. The muscles also play a vital role in controlling and stabilising the hip joint.

They tend to get injured in either the fleshy belly of the muscle or at the origin of the muscle where it arises from the pubis bone of the pelvis. A running or lifting action is commonly involved in the injury mechanism.

Injuries of the muscle belly tend to be easier to resolve. This in my opinion is due to the better blood supply here compared to that of THE TENO-PERIOSTEAL JUNCTION. This is the medical name for point at which the muscle arises from the pubis bone of the pelvis.

Inflammation at the origin of the wretched muscle can be challenging to treat, especially if the condition becomes long standing or chronic. Severe breakdown of this part of the groin muscle has ended the careers of more than one professional sportsperson.

Regarding this particular injury, What’s best are deep frictions if the condition has become chronic and difficult to resolve.

The Calf Strain

Calf strains are probably not as common as hamstring injuries. They are though equally as frustrating for the sufferer. The mechanism of injury here is normally an over exertion of the muscle. It can involve walking or running uphill or jumping and landing. Non sporting causes are frequently helping push someone’s car off the road if it has broken down.

There is usually a sharp pain in the muscle at the time of injury. They can be exquisitely tender to touch and cause a marked limp due to the loss of propulsion of the body weight from the heel to the toe. This strained muscle injury will normally involve either a tear of the medial or lateral head of the gastrocnemius muscle. These are the fleshy bits just below the knee at the back of the leg. The medial one, nearer the inner aspect, is more commonly torn than its lateral counterpart.

The calf muscle group also has a deeper component called SOLEUS. This particular muscle lies underneath the larger, bulkier gastrocnemius muscle. It is less involved in power production and is therefore less commonly injured. My reason for mentioning it here is that a strain of this muscle can be overlooked. Its rehabilitation will need a different approach and unless this is tweaked there can be persistent problems.

Treatment of Muscle Injuries

What does medicine say will fix a pulled muscle? Massage? The treatment of all strained muscles have familiar veins running through them. A definitive diagnosis helps, followed by immediate R.I.C.E. The fastest healing process will keep concurrent with a carefully guided rehabilitation program to restore maximum function. It is here that there are specific differences for each injury involving good stretching, strengthening and functional pattern regimes. In a future article we’ll discuss lat strain recovery and pinched back muscles.

What About Neck Pain?

aching neck and shoulders
acute neck pain

Continuous neck area pain is not far behind how bad low back pain in terms of the amount of constant problems it causes to both individuals and society. From a purely theoretical view point problems with the neck are more serious than those of the back if looked at in terms of the severity of the worst case scenario of a spinal cord injury. Here, however, we are talking about injuries that although painful and problematic are of a considerably less serious nature. The right medications exist like a pain killer, reliever to help relieve discomfort from tight tension, stiffness from a strained neck.

What we shall do here is cover the general anatomy of the neck, or cervical spine as it is called, before moving on to discuss common problems affecting the area and how to treat.

Anatomy

The neck is a simple yet complex arrangement of seven blocks of bone called vertebrae stacked on top of each other. The way they move is relative to each other via joints. One set of joint being between the bodies of the vertebrae separated by the intervertebral discs and the others via facet joints at either side of each vertebra allowing movement with the vertebra above and below.

From each side of the spine pass the nerves that branch off the spinal cord and travel to different parts of the body. Covering the whole spine are the muscles and intricate ligament systems for both stability and ways of movement.

Causes of Neck Problems

The majority of neck problems, upper or lower, can be narrowed down to three base factors.

* Degenerative This is where the natural ageing process results in thinner discs and cartilage and less flexible muscles and ligaments, amongst other things. Such changes cause normal movements and activities to become limited and painful as a result of the neck’s reduced ability to absorb shock and control the weight of the head.

* Postural. Poor or abnormal postures where the spine is out of alignment and loses its natural curvature over a prolonged period of time results in certain segments and structures of the spine cramp, be worn and damaged.

* Traumatic. This can be any type of injury or incident and can have a variety of effects across the whole spectrum of trauma. Falls, vehicle and sporting activities are the commonest causes of traumatic neck injury.

Neck Pain

As with all areas of the body there are common patterns of problems in the neck region that relate to both the anatomical structures and the causes mentioned above.

Neck Pain With No Trauma or Injury – This will commonly be due to a postural or degenerative problem. You may well be able to work out the cause by analyzing when the onset of pain was. Awaking with it signifies an awkward sleeping position for the nape of the neck and shoulders. Other causes may be excessive sitting, studying or driving.

Neck Pain with Radiation of Symptoms into the Arm – This normally signifies that the root of at least one of the nerves passing out from the cervical spine is irritated or compressed. Compression can result from ‘pinching’ of the nerve by the facet joint or part of the disc.

If you have pain, pins and needles or numbness IN BOTH ARMS you should seek URGENT MEDICAL ATTENTION.This is because symptoms on both sides may indicate the pressure on the spinal cord itself which obviously has serious consequences if not rectified.

Neck Pain with Radiation into the Shoulder Blade – Pain that runs down along the inside of the shoulder blade indicates a problem with the lower part of the neck. This pain can be very troublesome and may also indicate that the THORACIC SPINE, the part of the spine between the neck and the back, is involved.

Pain in the Neck Due to Trauma – This type of neck pain can be due to injury or inflammation in any of the structures of the neck: THE DISCS; THE FACET JOINTS; THE VERTEBRAE; THE LIGAMENTS; THE MUSCLES OR THE NERVES. Many of these structures are easily damaged and can take many months to recover from injury. This is why so many ‘whiplash‘ injuries from road traffic accidents take so long to resolve. The forces can cause the structures to be COMPRESSED, STRETCHED, CRUSHED, TWISTED or ROTATED in any combination.

Treatment, Therapy, Solution, Remedy

The thing is is that the best cure for a neck condition is such a massive subject dealing with so many variables and discussion points. Things a clinic can provide are some good, fast information to help heal intense, severe, sharp discomfort from injury. At the very least quick medication such as a painkiller for pain management in cases of extreme injury can be given for relief and to soothe and ease things. What’s left will also be covered in greater detail in a downloadable e book that will be available soon. We’ll also discuss other conditions like sciatica, stiff neck n shoulder pain, sprain, rear pain in a future article.