Back Pain

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The reasons for back pain are many and varied – there are a few important things to consider:

  • A proper diagnosis and management plan early on is really important
  • Exercise rather than rest is invariably better

Disc problems

This is commonly characterised by pain radiating down the arm or leg in a particular distribution reflecting irritation of one of the nerves that gets trapped by a disc herniation. When severe this can lead to disruption in the sensation or power to the upper or lower limbs and may require surgery to put right. However most discs (about 60-70 per cent) will get better within six weeks and just require some careful management.

Sometimes disc pain is only felt during the impact of sport and exercise and may reflect an annular tear of the disc. This is where the disc structure is damaged but does not result in a nerve being trapped.

Sports that may predispose to these sorts of injures generally involve rotation and impact forces and are not infrequently seen in rowers.

Gentle exercise and maintaining muscle strength and core stability are important factors in helping to minimise discomfort

Facet joint problems

Facet joints can cause pain either through arthritis or disruption in sporting action. This can be caused or aggravated by sports involving back extension (bending backwards) particularly with rotation. Sports such as bowling in cricket and gymnastics can cause particular aggravation.

Exercises to prevent postural aggravation, particularly a splay back posture, may help to minimise discomfort. Sometimes swimming, normally thought of as a good gentle exercise for backs, may aggravate as the back arches significantly when swimming with your face out of the water.

Spondylolisis/spondylolisthesis

This is a particular condition caused when even more pressure in extension and rotation is applied and causes a small break in the bony bridge supporting the side joint of the back, the ‘pars interarticularis’. Common in cricket, bowling, gymnasts and footballers, particularly young academy players. Rest from aggravating activity is important. A prompt diagnosis often with the help of an MRI is helpful and proper treatment is important. A persistent non-union of the fracture can occur not uncommonly and be a cause of niggling discomfort.

Muscle strains

It is not uncommon to get a back strain – when the back is particularly weak or deconditioned it can happen with trivial levels of exercise – the key to improving this is to increase exercise and mobility and to address posture and core stability. Building up to more energetic exercise or heavier loads is important to prevent recurrent symptoms.

Work posture can be a precipitant of back discomfort when later going out to play sport. It is always worth warming up and then a gentle range of motion stretching prior to exercise.

Should I exercise when I have back pain?

The short answer is that most back pains will actually improve with exercise in the long run. You should ask about what the most appropriate exercise is for your sort of back pain and whether there is any particular reason why you should not exercise.

When should I worry about back pain?

Very occasionally your back pain is from a significant medical condition which requires active treatment. We can often pick this up by looking for certain ‘red flag’ clues such as:

  • Significant muscle weakness or wasting
  • Pain that prevents sleep or is unremitting at night
  • Significant weight loss
  • The first onset of pain in people older than 50 or younger than 20
  • A history of cancer, drug abuse, significant infection or fever
  • Difficulty in passing urine or maintaining bowel or bladder continence or numbness in your perineal area
  • Unusual neurological signs when we examine you

In these situation we would suggest an early intervention and investigations to establish the cause of the problem and suggest you seek attention promptly.

Most back pains however, whilst being a nuisance, are generally not a cause for alarm and not infrequently over-protection of your back may lead to more trouble than the problem itself. If in doubt, ask.

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