As an osteopath and strength trainer specializing in the treatment and management of persistent pain, I have helped countless people with back pain. At our clinic, Southampton Physio, we see people every day who have put up with back pain for far too long… from office workers in Bitterne and Portswood, to people commuting in from Fareham, Hythe and Bursledon.
They all have one question, why does my back still hurt and how can I treat it?
Back pain can start seemingly from nowhere… A muscle spasm, a disc injury, irritation to a facet… most of the time these are small injuries. The body’s reaction can be huge, and you end up suffering with severe pain, your muscles go into spasm, the area local to the injury can become inflamed. In severe cases this can impact the nerves coming from the spine and cause pain to travel down those nerves into the legs.
For 95% of people, this resolves in less than six weeks. But for an unfortunate few, this pain can go on for years. There are many reasons for this. Sometimes it’s a genetic predisposition towards an overactive “pain reaction” that’s difficult to get under control. If back pain runs in your family, or you believe that your back is inherently weak or unstable, then you might react to the pain in a different way. Some people avoid movement altogether after an injury and never return to normal levels of activity, which can lead to deconditioning in the back which predisposes you to future re-injury.
Whatever the exact reason, in some people that initial episode starts a pain cycle that reinforces itself over time. As the pain continues and you don’t find a solution, the nervous system can start to get increasingly sensitive. Movements or forces through your lower back that were previously well-tolerated begin to trigger the “pain system” and cause your muscles to spasm, and your back feels stiffer and stiffer. This motivates you to move less and less… leading to more sensitivity, deconditioning, and the cycle continues.
All of this can lead to increasing levels of anxiety about the pain itself:
What if my back pain never goes away?
Will my back pain be permanent?
Do back injuries ever get better?
These questions can play on your mind and contribute to this cycle, until eventually this pain can come to dominate every aspect of your life. You stop doing things you used to love, you stop going out so much. You become more isolated, less active and all of this has knock on effects on your mood, your health… and your back. This cycle is what causes a back injury to get worse over time.
Now, this helps to explain the why. But keep on reading and we’ll go through how we treat lower back pain at Southampton Physio, including some ways to improve pain that you may never have considered.
The first thing that we do is to identify that this is back pain caused by an injury and not something more serious, by ruling out red flags.
The main red flags for back pain are:
- Severe pain in both legs, with or without tingling, P&N or numbness
- Changes in sensation in around the genitals and back passage
- Changes in bladder or bowel functioning since the onset of back pain
- Changes in sexual function or sensation during sex
These are signs of a condition called cauda equina syndrome and require immediate medical attention. This is the most serious back injury.
There are other medical conditions that can present as lower back pain, and for that we would ask questions related to your general health. If your back pain has been going on for months or years, then the chances of it being something medically serious are very low.
Once we are happy that your back pain isn’t anything sinister, we’ll assess you to start to work out the best treatment options.
How to treat it?
At this stage, people often ask exactly where the pain is coming from: is it a muscle or is it a disc? The fact is that we can’t tell. Even with MRI scans and x-rays we can’t tell exactly where the pain is coming from. We can see on an MRI that there may be damage to discs, or degeneration in around the spinal structures, but these findings are common in people with no pain at all.
The questions we ask, and the questions you can ask yourself, to begin to form a treatment plan are:
- What aggravates your pain? This could be movements such as bending forward, day-to-day activities, activity levels on a given day or week, stressful events, and times of life? Try to identify the triggers for your pain.
- What relieves your pain? Is there anything you know helps with the pain? This could be certain exercises or stretches. It could be movement generally or resting more. It could be treatments that you’ve tried such as massage, spinal manipulation, acupuncture or breathing and stress reduction techniques.
- What do you avoid now because of the pain? This could be certain movements or certain activities.
- What would you be doing differently if you had no pain tomorrow? This gives us somewhere to aim for, a goal to work towards.
Along with a detailed physical assessment, these questions inform our treatment plan.
Relieving severe back pain
The first stage is to get you some relief if you don’t already have something that does that. In clinic we might use hands-on interventions such as massage and spinal manipulation, to help to calm down the muscles and nervous system that are stuck in this ongoing “pain reaction”. These treatments are only ever temporary though, and so we would coach you on different things that you can do yourself at home to get relief.
Below are a few of the kind of stretches we might use.
Finding relief is the first place we go for a couple of reasons. Firstly, you need relief from the pain! This pain has been dominating your life for months or years… so our priority is to ease it somewhat and improve your quality of life.
If this pain is affecting your sleep, then getting it under control improving your sleep is our number one priority. Without sleep the rest of the rehabilitation process can’t get going fully.
Secondly, relief helps to settle the reaction going on your back, and particularly if it’s something you can do at home by yourself, it gives you the confidence to begin the rehab process knowing that you can settle the pain down again if it flares up.
Thirdly, you need some relief from the pain so that you can begin the real process of recovery: gradually challenging yourself with incremental increases in activity levels as well as mobility and strength exercises for your back.
How to Get Rid of Back Pain
The simple and unfortunate fact is that if you’ve had back pain for many months or years, you probably can’t just get rid of it. You can get short term relief as we discussed above but healing from chronic lower back pain is a case of pro-active self-management.
There are no magic cures or instant fixes… but you can get to a place where back pain is just a minor nuisance that no longer dominates your life. You can get to a place where you’re able to do everything you want in life despite the occasional flare up.
How you get there will be unique to you. For some people it might be all about strength training and exercise. For others, it may involve learning to manage stress better. For others still it might be tackling long standing sleep issues.
Everyone will have to learn how to pace their lives around inevitable flares of back pain and manage their activity levels in a different way. It’s not an easy process, but it’s one that gives you so much more than just pain relief. As someone who’s done it themself, trust me.
To summarise
- Back pain can start from seemingly trivial injuries, often we can’t identify what caused it in the first.
- Relatively minor injuries can cause massive reactions by the body. Despite the pain being excruciating it is usually nothing serious and 95% of people will recover after six weeks.
- Not recovering after six weeks doesn’t necessarily mean your injury is worse or that there’s something seriously wrong – some people are at a higher risk of prolonged “pain reactions”. The reasons why are complex and will be unique to you.
- If you haven’t already, you should get yourself assessed. If you are local to Southampton, Eastleigh and Winchester you can book in to see us here.
- Finding relief is key, the stretches above are a great place to start.
- Find your baseline for activity that you can currently tolerate then work from there. Small, incremental increases in movement to improve your capacity.
- Be patient and be flexible. There is no magic cure. But small improvements over time will equate to a massive improvement in your quality of life.
- If you need help, reach out. If we can’t help you directly, we can point you in the direction of the services that could.
