Back Pain, Lower Back Pain & Sciatica

Back pain is as one of the most common reasons people go to medical practitioners, and accounts for a large proportion of missed days at work. Four out of five people will experience back pain at least once in their lives (1).  Around 25% of people experience back pain on any given day, and up to a third of people don't fully recover in the year after onset of back pain. While for some people back pain is little more than discomfort, for others it can leave them incapacitated (9).

Serious conditions are rare causes of back pain (1).

Some people may be prone to back pain, as the back area supports a lot of our body weight, and relies heavily on the strength of the vertebrae in our spine. If the spine is not stabilised or has poor functional control areas of weakness can occur, resulting in irritation of nerves in the spine, or in a bulging disc, which places pressure on the spinal cord and/or spinal nerves.

Back pain has a variety of causes, from simple muscle strains to damaged discs. The following are common causes:

1. Sacroiliac Syndrome

Your Sacroiliac or SI joints sit on either side of your tailbone at the base of your spine. They are large joints which are important in everyday life because they move when you walk and they dampen the shock that each step places on your body. Think of them as shock absorbers.  But they can become locked which causes a generalized dull ache in the low back which may also be felt in the buttocks or even down the back of the thigh. Protective muscle spasm may also occur which limits normal activity; however, there are no muscles that actually cross the SI joints. That is one of the reasons this type of low back pain does not respond to stretching and exercise alone and spinal manipulation may help relieve pain (2,11).

2. Facet Joint Syndrome

This is a very common cause of lower back disorders. Facet joints occur in pairs at the back of each vertebra and they prevent excessive motion and guide spinal movement. When these joints are exposed to excessive trauma - from sports, work, normal aging, etc. - they can become inflamed and motion may be restricted at a particular level of your spine (13). This may cause low back pain or even pain which is felt in the back of the thigh (13). Once again, protective muscle spasm may further complicate the situation.

3. Ruptured /Herniated/Slipped/ Bulged/ Prolapsed Discs

The term "slipped disc" ruptured ,herniated, prolapsed or bulged discs are terms that describe disc damage. Each vertebra is separated from its neighbour by a cushioned disc. A disc which has weakened due to repetitive injury or small traumas may tear, bulge, prolapse or sequestrate (rupture). A rupture allows some of the soft center material to leak out through the tough outer casing into the vertebral canal. This "leak" can press on the nerves. In the lower back  this can cause radicular pain which can travel down your legs, causing sharp pain down to your toes(13). This leg pain is often worse than the back pain itself. This is a less common form of back pain than SI or Facet Joint Syndrome, but it is somewhat more serious. Ruptured discs can be brought about by a sudden movement, lifting, and sometimes just general wear and tear (13).

4. Muscle Strains and Ligament Sprains

Muscle strains and ligament sprains are most often caused by poor posture, lifting injuries or an old untreated back injury (14). Symptoms can be chronic backaches with occasional spasms.

5. Scoliosis (curvature of the spine)

Scoliosis is most common among teenage girls. It is important that it be screened for after the age of 10. Your chiropractor can show you how. While few symptoms may occur, the long term effects can be quite significant.

6. Sciatica

Sciatica describes a set of symptoms that include hip, buttock and leg pain radiating from the lower back along the path of the sciatic nerve (13). The nerve runs through the buttock, down the back of the thigh and leg into the foot (14). Discomfort ranges from mild to incapacitating, and my be accompanied by tingling, numbness or muscle weakness. Sciatica is a term often misused to describe any pain in the leg that may originate in the lower back. True sciatica is a radicular pain coming from the nerve root (sharp razor type pain) down the sciatic nerve (13). The pain comes from irritation to the duramata which is a pain sensitive structures surrounding the spinal chord and nerve roots.

Sciatica is a set of symptoms not a diagnosis. This point is important, because treatment of sciatica will often vary, depending on what is irritating the nerve, causing pain.

How can a Chiropractor or Osteopath help?

If pain is present for more then a couple of days seek attention from your primary care provider. There are a number of effective treatments for back pain  and the role of your practitioner is to help you via hands-on treatment and appropriate self management such as appropriate excercises (2,6,7,10,11).

What can you do yourself?

There are some things you can do to help prevent relapses, or to minimise the severity of lower back pain. Some useful tips include:
  • Avoid sudden bending, twisting or sharp movement while in pain. This can aggravate pre-existing vulnerabilities to back problems in tissue inflammation, then applying heat is not advised for the first 24-36 hours.
  • If recent onset back pain is very painful then the use of cold or heat or simple analgesics (such as Paracetamol) may be beneficial (3,4,5).
  • Avoid loading the spine for the first 60 minutes after awakening
  • Maintain proper posture at all times
  • Make sure that your workspace is ergonomically designed. This includes things like a supportive chair, a well-placed computer monitor and a workstation layout that does not require a lot of twisting and turning (12)
  • Engage in regular exercise. Even if you are suffering from back pain, bed rest is often not the most preferable option. Low-impact exercise such as walking or swimming will help the back muscles remain active and loose
  • Being fearful of movement and concerned that you may do more damage is often a factor in slowing recovery, so try and remain active within your pain limit (7)
  • When exercising, ensure you correctly warm up and cool down every time.
  • Wear comfortable flat or low-heeled shoes


Sources:

https://www.coca.com.au/publications/patient-information/

References

1. Walker BF, Muller R, Grant WD.  Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther. 2004 May;27(4):238-44. 

2. Sidney M Rubinstein, Marienke van Middelkoop, Willem JJ Assendelft, et al. Spinal manipulative therapy for chronic low-back pain. Editorial Group: Cochrane Back Group . Published Online: 16 FEB 2011  -  Assessed as up-to-date: 5 DEC 2009. DOI: 10.1002/14651858.CD008112.pub2

3. Simon D French, Melainie Cameron, Bruce F Walker, et al. Superficial heat or cold for low back pain. Editorial Group: Cochrane Back Group . Published Online: 14 APR 2010  -  Assessed as up-to-date: 11 OCT 2005. DOI: 10.1002/14651858.CD004750.pub2 

4.Willem JJ Assendelf, Sally C Morton, Emily I Yu, et al. Spinal manipulative therapy for low-back pain. Editorial Group: Cochrane Back Group. Published Online: 8 OCT 2008  -  Assessed as up-to-date: 30 JAN 2000. DOI: 10.1002/14651858.CD000447.pub2

5. Pepijn DDM Roelofs, ick A Deyo, Bart W Koes, et al. Non-steroidal anti-inflammatory drugs for low back pain. Editorial Group: Cochrane Back Group . Published Online: 17 MAR 2010  -  Assessed as up-to-date: 16 OCT 2007DOI: 10.1002/14651858.CD000396.pub3
6. Arno J Engers,Petra Jellema, Michel Wensing, Daniëlle AWM van der Windt,et al. Individual patient education for low back pain. Editorial Group: Cochrane Back Group .Published Online: 17 FEB 2010  -  Assessed as up-to date: 24 SEP 2007. DOI: 10.1002/14651858.CD004057.pub3
7. Jill Hayden, Maurits W van Tulder, Antti Malmivaara, Bart W Koes. Exercise therapy for treatment of non-specific low back pain. Editorial Group: Cochrane Back Group . Published Online: 17 FEB 2010  -  Assessed as up-to-date: 30 SEP 2004DOI: 10.1002/14651858.CD000335.pub2 
8. Nicholas Henschke, Raymond WJG Ostelo, Maurits W van Tulder, et al.  Behavioural treatment for chronic low-back pain. Editorial Group: Cochrane Back Group. Published Online: 7 JUL 2010  -  Assessed as up-to-date: 31 JUL 2009. DOI: 10.1002/14651858.CD002014.pub3

9. Nadège Lemeunier, Charlotte Leboeuf-Yde, Olivier Gagey. The natural course of low back pain: a systematic critical literature review Chiropractic & Manual Therapies 2012, 20:33 doi:10.1186/2045-709X-20-33

10.Oliveira VC, Ferreira PH, Maher CG, Pinto RZ, Refshauge KM, Ferreira ML. Arthritis Care Res (Hoboken).  Effectiveness of self-management of low back pain: Systematic review with meta analysis.  2012 Nov;64(11):1739-48. doi: 10.1002/acr.21737.
11. Bruce F Walker, Simon D French, William Grant, Sally Green. Combined chiropractic interventions for low-back pain Editorial Group: Cochrane Back Group.Published Online: 14 APR 2010. Assessed as up-to-date: 27 NOV 2009. DOI: 10.1002/14651858.CD005427.pub2
12.Pierre Côté, Kristi Randhawa, et al. Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults. Cochrane Database of Systemic Reviews. Aug 2012 
13. McGill S (2016). Low Back Disorder. Evidence-Based Prevention and Rehabilitation 3rd Ed. Human Kinetic Publishers. ISBN: 1450472915
14. 5.. Magee DJ (2008). Orthopedic Physical Assesment Ed 5. pg 972-1012. Saunders Elsevier. ISBN-13:978-0-7216-0571-5


Additional  References
Balague F, et al. Non specific lower back pain. Lancet 2012;379 484-491
Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical Practice Guideline no. 14. AHCPR Publication No. 95-0642. Rockville MD: Agency for Health Care Policy and Research, Public Health Service, US, Department of Health and Human Services. December 1994. Search date not reported; primary sources The Quebec Task Force on Spinal Disorders Review to 1984, search carried out by National Library of Medicine from 1984, and references from expert panel
Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128–2156.
Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther 2004;27:388–398.