Back Pain Specialist:

Personal Experience

My own personal experience of pain has strongly guided my practice philosophy. Back pain, perhaps more so than other joint condition, creates a degree of worry and concern in the minds of the sufferer. These concerns can readily become all-consuming and affect every aspect of life.

I recall seeing several different therapists for treatment and still being unclear as to what was wrong and who the best therapist was to help.

I received varying diagnosis from muscle spasm to sciatica and a ‘slipped disc’. Finally, an MRI scan confirmed the presence of a herniated disc. This experience has led to a career devoted to helping people who find themselves in similar circumstances.

back pain, spine and vertebral treatment at Naas Physio & Chiropractor Clinic

Ross Allen is Ireland’s only dual qualified Chartered Physiotherapist & Chiropractor.

What causes back pain?

Musculoskeletal drivers of spinal pain include disc herniations, ligament, muscle or joint injury. Some recover in a short period of time but others can remain in constant or intermittent pain for weeks, months, or even years. 

What is the difference between acute & chronic pain?

Acute pain: lasts for a short period of time, normally days to weeks, prior to recovery.

Chronic pain: on the other hand, is a pain that lasts for a longer period of time (from months to years).

Much like other chronic (long-term) conditions such as heart disease or obesity, the longer it is present the more challenging the condition & the more difficult it is to recover fully.

We specialise in the management of chronic pain & have helped many people recover from long-term pain in cases where no prior intervention has been successful.

What lessons do astronauts provide?

Muscle and joint pain is commonly reported by Astronauts who spend several months in space.

A huge 70% of astronauts report having back issues.

In astronauts with a history of back pain there is a 100% re-occurrence rate. So what is it about space travel that creates an environment where pain is so prevalent?

Recent research suggests that issues in astronauts most likely arise due to changes in spinal length and wasting of the muscles that stabilise and support the spine.

Researchers have found that while in space, the spine lengthens and flattens, losing its natural curve (lordosis). This is associated with herniated discs (bulging disc) and the presentation of moderate to severe pain.

What does the research say about lack of exercise and spinal pain?

A recent study (1) found that the astronauts muscles, responsible for posture and stability, had reduced in size and that this likely contributed to their pain.

The authors also found that, following 12 months of rehabilitation, the size of most of the muscles had returned to normal.

The same mechanism of disuse and deconditioning of muscles in astronauts is also thought to induce pain in the normal population. But instead of a lack of gravity causing these changes, deconditioning occurs due to lack of exercise and sedentary lifestyles such as sitting in front of a computer all day.

The astronauts back rehabilitation protocol

A recent rehabilitation programme for astronauts (2) based on research of both astronauts and the normal population recommends;

  • Rehabilitation exercises should begin with spinal stability and posture exercises with special attention to maintenance of spinal curves
  • Exercises should progress to trunk strengthening once lumbar posture is restored
  • Exercises should progress to more strenuous general resistance exercises and cardiovascular training.

How Long Does it take for Back Pain to Resolve?

Research by Croft et al. (1998) reported that, contrary to popular belief, pain does not naturally resolve over a short period of time. His research was ‘consistent with the interpretation that 90% of patients with pain in the lower back in primary care will have stopped consulting with symptoms within three months.’ 

However most will still be experiencing pain and related disability one year later. Of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability. Therefore, it is very important to intervene early & identify the causes early to prevent recurrence.

What causes Sciatica?

When pain is present at the base of the spine, the presence of a disc herniation can give rise to symptoms commonly referred to as sciatica. Many patients attend the clinic reporting that a friend or physiotherapist have told them they have sciatica. The problem with this diagnosis is that it does not identify the source of the pain.

Sciatica simply means a pain in the distribution of the sciatic nerve, which runs down the thigh to the foot.

Like pain in any other part of the body, the important thing is to identify whether the source of these symptoms are from the low back as would be the case with a disc herniation (mistakenly referred to as a ‘slipped disc’), or whether the origin is the buttock or the leg itself, as may occur with a hamstring strain.

Is bending dangerous if you have back pain?

The approach of lifting with the legs and avoiding bending from the back is “common knowledge” as a key mechanism for protecting the back from injury. However, this management approach is no longer scientifically valid.

Despite this, proper lifting technique is taught in workplaces across the globe, and also frequently, in physiotherapy clinics. How many times have you heard someone being advised to “keep the back straight” and “bend from the knees”. Questioning such firmly entrenched beliefs is part of the scientific process. Unfortunately, education on lifting technique has not been shown to reduce the incidence of low back pain. 

Bending the back more when lifting has not been shown to be linked to back injury!

Should I Squat or Stoop When Bending?

Spinal compression and the pressure present within the spinal discs does not appear significantly different whether squatting or bending from the spine when lifting. The forces were found to be equal or slightly higher in squat than in stoop lifting. Only when the load was lifted from between the  feet did squat lifting cause lower spinal moments, although the difference was marginal. 

How can a Chiropractor Help with Back Pain?

A Chiropractor specialises in the management of back & neck pain. The education of a Chiropractor is focussed primarily on the spine & Chiropractors are educated to one of the highest standards of any of the health professions.

The ‘Sweden Report’ demonstrated that the 4-5 year university training programme for a Chiropractor was the equivalent of Swedish medical education.

One of the largest scientific analysis of low back injury called ‘The Manga Report’ reported that spinal manipulation such as utilised by a chiropractor was more effective than alternative treatments for the condition. It also found that manipulation used by chiropractors was safer than other medical interventions utilised.

How can a Physiotherapist help my Pain?

The initial goal of your physio is to rule out a serious cause for your pain. The physio will then perform specific test to identify the potential presence of a disc bulge which may be causing pain.
The literature clearly shows that the earlier the intervention, the better the long-term outcome. Once spinal pain becomes chronic (long-term) then it is progressively more challenging to address & can become severely debilitating.
Physiotherapy is very effective with musculoskeletal disorders (MSDs). In one study reported on the Chartered Society of Physiotherapy website, 80 per cent of people who had physiotherapy for their MSD were able to carry on working and did not have to go off sick.
See: http://www.csp.org.uk/your-health/conditions/back-pain#how-can-physiotherapy-help-back_pain
Common questions for spinal pain sufferers:
  • Do orthotics help decrease pain?
  • Do back belts help manage symptoms?
  • Are spinal injections effective?

What do the N.I.C.E Guidelines Recommend?

Should I use orthotics for back pain?

1.2.3 Do not offer belts or corsets for managing of low back patients with or without sciatica.

1.2.4 Do not offer foot orthotics for managing low back symptoms with or without sciatica.

Are Spinal injections good for Back Injury?

1.3.1 Do not offer spinal injections for managing low back symptoms.

Should I have an MRI scan for my Back Pain?

1.1.4 NICE Guidelines do not recommend the routine use of imaging in such cases 

 

Are anti-inflammatories good for back pain? British Medical Journal Research

..it is now clear that paracetamol is ineffective for spinal pain….

The authors collated the results of 35 scientific trials (RCT’s) and showed that NSAIDS did not provide a clinically important improvement in comparison to placebos.

At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo. There is an urgent need to develop new drug therapies for this condition.

NSAIDs increased the risk of gastrointestinal reactions by 2.5 times, which can include internal bleeding

 

 

We are here to help you achieve an accurate diagnosis and to provide a tailored treatment plan for your pain. A component of home exercise is generally required to optimise results and to achieve lasting relief from your symptoms.

For further information on conditions treated go to: https://www.physioclinic.ie/chiropractor-naas/

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References

1. Crodt et al. (1998). Outcome of low back in general practice: a prospective study. British Medical Journal, 1998. May 2;316(7141):1356-9.
Ref: https://www.ncbi.nlm.nih.gov/pubmed/9563990
2. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.
Ref: http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml
3
https://www.nice.org.uk/guidance/NG59/
4
BMJ. 1998 May 2;316(7141):1356-9. Outcome of low back pain in general practice: a prospective study. Croft et al. (1998). https://www.ncbi.nlm.nih.gov/pubmed/9563990
5. Machado GC, Maher CG, Ferreira PH, et al. Non-steroidal anti-inflammatory drugs for spinal: a systematic review and meta-analysis. Saraceni N, Kent P, Ng L, Campbell A, Straker L and O'Sullivan P (2020) To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back? A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 121-130. 

8. https://fitnessvolt.com/lower-back-pain-athletes/