Why does back pain come back? And how to prevent it

Man with poor posture at table at risk of back painBack pain recurs when the stresses and strains on your back overcome your body’s ability to deal with them. Daily activities like bending, lifting and long periods of sitting with poor posture can put a strain on the spine which it can normally cope with very well. Unfortunately, if there is an underlying issue which reduces your ability to manage these forces then the back muscles, joints or discs can get irritated and start to hurt.

Back pain often comes and goes. If you have a mild episode of back pain it will often get better by itself over a few days or week or two. Even though the pain may be gone, however, the underlying dysfunction which caused the problem in the first place may still be lurking. When this happens a simple movement may strain something in the back and the pain flares up again.

As each episode of back pain strikes the more likely it is that you will have another back attack. These episodes often get worse the longer the problem is unresolved and get more and more frequent and last for longer each time. So what can you do about it?

There are three things that help reduce recurrent back pain:

  1. Take regular exercise

Staying active is the single most important thing to prevent back pain from returning. Whilst back muscle or core exercises are very useful in the treatment of low back pain, no one particular exercise regime has been shown to be better than any other when it comes to prevention. This means that any sort of regular moderate exercise can help prevent back pain. It’s probably more important to do something that you enjoy and is easy to get to so that you keep doing it.

  1. Watch your posture and movement

Well known simple things make a big difference like bending your knees when you bend and lift; not sitting at your desk or on a sofa for too long and making sure your normal back curve is maintained by putting a cushion in the small of your back. Sometimes you will need to avoid deep soft sofas too. Being aware of these things is often enough to improve your posture sufficiently to take the strain off your back.

  1. Get stiff spinal joints sorted out

Even though the low back pain may have gone, silent spinal joint dysfunction can persist. Improving the mobility of these joints has been shown to prevent future bouts of pain. That’s why we recommend a periodic check-up by one of our chiropractors every few months if you are prone to recurring back pain. It can make a big difference and can save time and money in the long run.

 

Stress affects back pain

Other things can also increase the likelihood of another bout of back pain. Stress, anxiety and depression have been associated with persistent or recurrent low back pain. A post on this is coming soon.

Why an accurate back pain diagnosis is essential

Back pain is not one condition but several conditions causing similar symptoms. A muscle spasm, disc derangement and a spinal joint dysfunction all cause low back problems that can refer pain down to the buttock and leg and a skilled chiropractor or physio can tell which problem it is likely to be. Whilst several conditions can co-exist an accurate diagnosis is important because the treatment is different for all three.

The diagnostic confusion is made worse by the different experts who treat back pain because they often use different terminology to describe the same thing, recommend different treatment based on their area of expertise and frequently ignore the evidence that their approach has been shown to be ineffective and so leave you, the patient, in pain and more confused about what is wrong.

Most back pain is caused by irritation to:

  1. joints,
  2. discs,
  3. muscles or
  4. nerves of the spine.

This irritation happens with repetitive minor trauma such as bending and lifting or, more rarely, by a single traumatic injury such as a fall or accident. It can also be caused by inactivity which causes the joints of the spine to stiffen up and the back support muscles to become weak such as sitting at a desk for long periods.

If the joints of the lower back get stiff they are less able to carry out normal movements and this can lead to further joint irritation, stiffness and pain. This is often called Facet Joint Syndrome. The nerves around the stiff joints get irritated too and fire off alarm signals into the nervous system which can cause further symptoms such as tingling and pain referred down to the hips and legs. This can mimic sciatica.

Occasionally, the nerve irritation can cause muscles in the legs to weaken and this can lead to problems in the hips and knees. How this occurs isn’t clear but anyone with hip or knee problems seeing us here at Sundial will get a thorough muscle and spine check-up.

We treat back pain with an effective step by step programme to rebuild strong and healthy backs so you can lead an active and fulfilling life.

 

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Bare as you dare – how sunbathing prevents back pain

The sun is shining; it’s warmed up; time to take your clothes off!

If you are suffering from ongoing back pain, then you could be deficient in Vitamin D. This hormone is responsible for a wide range of processes in the body including bone and muscle function. A commonly missed cause of back pain is Vitamin D deficiency, especially over a long winter. At least 50% of people in the UK show signs of vitamin D deficiency and many will have increased back pain as a result.

Common signs of vitamin D deficiency

  • muscle and bone aching
  • pain sensitisation, lower pain threshold
  • fatigue
  • depression
  • weakness
  • muscle soreness after exercise

Vitamin D is essential for bone formation as it helps your body absorb calcium from food. If you don’t have enough Vitamin D you can get a condition called osteomalacia. The dull, aching pain associated with osteomalacia most commonly affects the lower back, pelvis, hips, legs and ribs. This pain can be worse at night, or when you’re weight bearing. Vitamin D deficiency may cause morning back pain in some people too.

How much Vitamin D is enough?

There are various ideas about what the minimum blood levels for Vitamin D are required. This is a measure in nanomoles per litre of blood (nmol/L). Severe deficiency is anything below 25nmol/L, but anyone below 50nmol/L is considered deficient. Optimum health is often thought of a being above 85 nmol/L although more than 125nmol/L can be required for some people.

How can you get enough Vitamin D?

Fortunately, it is easy to get enough Vitamin D for free as you make it in your skin. Sunlight contains ultraviolet (UVB) rays that stimulate Vitamin D production. UVB rays also cause sunburn, however, so it is important to avoid over-exposure. If you cover up or use sunscreen, you will not produce Vitamin D so only aim for short exposure.

A sensible approach is to aim for 10-30 minutes exposure on as much bare skin as you dare, depending on how sensitive your skin is, several times a week when the sun is strong enough; in the UK that is from April to September. Full body sun exposure with no sunscreen will produce up to 20,000iu (500 μg) in 30 minutes. More importantly, once you have made enough Vitamin D your skin stops producing it so you can’t get too much.

Vitamin D supplements

Over the winter or for if you are severely deficient then supplements are the only way to go. In your diet oily fish such as salmon, mackerel and sardines provide some vitamin D but you would, for example, need to eat 20 tins of salmon a day to get 5000iu.

Here at Sundial we recommend a liquid Vitamin D supplement which is highly absorbable and inexpensive. The chewable calcium based supplements from ordinary shops are often too low in Vitamin D to help much.

Summary

  • Vitamin D deficiency is common and can cause back pain
  • Safe sun exposure on bare skin from April to September is beneficial
  • Taking a good quality supplement over the winter prevents deficiency

For more information and references:

https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/

https://www.skincancer.org/prevention/uva-and-uvb

https://www.hsph.harvard.edu/nutritionsource/vitamins/vitamin-d/#new-vitamin-d-research

https://www.healthline.com/nutrition/9-foods-high-in-vitamin-d#section2

 

Back pain in pregnancy and chiropractic

freestocks-org-71789-unsplash

During pregnancy your body changes to adapt to your growing baby. These changes happen fast and you can experience pain and discomfort in your pelvic and lower back area.

Hannah’s story

Hannah came to me here at Sundial during her 4th month of pregnancy because she was experiencing pelvic pain for few weeks and the intensity of pain was increasing with time. She was also suffering with pubic pain for the last few days.

She would feel more pain turning in bed, walking and going up or down stairs. Being a nurse Hannah needed to be on her feet most of the day and she desperately needed relief.

After an examination I explained to Hannah that she was experiencing pain because of a sacroiliac dysfunction, a lack of movement in the joint of the pelvis.

These types of pain are very common during pregnancy. In fact 20% of pregnant women suffer with pelvic pain and 50 to 85% with low back pain. This is mainly due to the hormonal changes during pregnancy as your body starts to produce relaxin, the hormone that relaxes your ligaments in order to increase the space for your baby and birth. Also mechanical changes occur as the pregnancy goes along. As your tummy gets bigger the curve of your lower back increases and creates pressure on your back joints and muscles too.

We started working on this sacroiliac dysfunction using very gentle techniques to free up the joints and also working on the ligaments and muscles of the pelvis with gentle pressure. I also gave Hannah stretches and exercises to stabilise her core muscles and pelvis at home.

I saw Hannah regularly throughout her pregnancy in order to maintain the right sort of movement in her pelvis and, fortunately, she didn’t experience pelvic pain anymore!

Can arthritis of the spine cause back pain?

Does arthritis, specifically osteoarthritis, cause low back pain? In this video Brighton chiropractor and back pain expert, Matthew Bennett, reveals the answer and explains what osteoarthritis of the spine actually looks like.

Free physio exercise routine (worth £42) with free spinal check-up

Low back stretchMost people think that having a healthy back is matter of luck, a matter of avoiding accidental injury and bending a lifting properly. Whilst these things certainly help there are three things that research has shown to be the most effective way of treating and preventing back pain.

Firstly, and most importantly, keeping fit and active has the biggest impact on preventing back problems. Initially, a few days rest may help a bad back but getting active early on is key to a full recovery. Once your back is better it is important to maintain levels of activity and there are certain simple exercises that you can do at home. These exercises can also prevent back pain coming on in the first place.

The second thing that will help keep your back in tip top condition is getting treatment sooner rather than later. If back problems are not clearing up or keep coming and going it may be a sign that that the condition is slowly worsening and this can lead to chronic, ongoing pain.

The third solution to keep your back healthy is regular preventative check-ups. Back problems come on because the spinal joints gradually stiffen over time, causing reduced movement, inflammation and pain. We can check for the early signs of spinal stiffness and our treatment can unlock the stiff joints and prevent the pain from coming on in the first place.

For January, we are offering a free spinal check-up with a chiropractor combined with free 30-minute physio assessment and personalised exercise routine (worth £42) for everyone seeing a Sundial chiropractor. To book in online – www.sundialclinics.co.uk or call Sundial Queens Road, 01273 774114

 

Terms and conditions: One free spinal check up and one free physiotherapy exercise session is available on request. To be eligible to claim you must receive a session with a Sundial chiropractor between 2nd – 3rd February 2018. Only one free chiropractic check-up and one free physiotherapy session is allowed per person and it must be taken by 31st March 2018. The free sessions are not transferable and cannot be exchanged for the cash equivalent. 

Preventing low back pain

low back treatment, chiropractor BrightonRecent research shows that low back pain can be prevented with regular chiropractic care. Researchers from the Karolinska Institute in Sweden reported that early results from their randomised control trial showed significant improvements in the recurrence of back pain. These results, as yet unpublished, were reported at the latest European Chiropractic Union Conference in Cyprus, May 2017.

In the trial, people with recurrent low back pain were divided into two groups. Both groups were treated with an initial course of usual chiropractic care which consisted of spinal manipulation, mobilisation, exercises and advice. One group was then told to come back every few months and the other group was told to come back only if and when the pain recurred.

The group that were told to come back every few months experienced nearly 20 fewer pain days over the year.  On average they had two more treatment visits than the other group.

This result confirms for the first time that regular chiropractic care can have a significant influence on the course of low back pain. People with recurrent episodes of back pain should consider regular preventative check ups to reduce the impact of their back pain.

Here at Sundial we recommend periodic check ups every few months based on your history and the severity of the problem. We monitor progress through regular reassessments and online questionnaires to help us improve our care.

Latest research show what works for sciatica

Back manipulation - Brighton chiropractorEffective treatment for sciatica has been hard to prove. There may be many reasons for this but recent research has attempted to analyse all the best studies and combine the results in a so-called meta-analysis. The research team from Bangor University looked at more than 120 studies comparing 21 different treatment strategies. What they found will surprise many doctors and patients alike.

Previous studies have often found little or no significant improvements between various treatment strategies. This understanding combined with the fact that most sciatica gets better over a few months all by itself has meant that usual medical treatment has been to reassure the patient, prescribe pain-killers, and send them on their way. This new study should change that approach.

The researchers from the North Wales Centre for Primary Care Research concluded that for the best overall outcome significant improvements followed disc surgery, epidural injections, nonopioid analgesia, manipulation and acupuncture although disc surgery and epidural injections were associated with some adverse effects. If the only consideration was pain relief then epidural injections helped as did certain anti-inflammatory drugs. The interventions that were shown not be effective were bed rest, certain strong pain killers (opioids like codeine), traction and some surgical procedures like discectomy. Lead researcher Ruth Lewis said  ‘The most interesting finding was that opioids are not effective. The lack of effect is probably due to the type of pain you’re dealing with.’

What sciatica treatment should you try first?

Back examination - Brighton chiropractorThe NHS Pathfinder helps identify what treatment is best and when to seek it out. First of all you need a thorough assessment and examination by a competent health care professional such as a GP, of course, but also a chiropractor, physiotherapist or osteopath. This first assessment is important to rule out serious diseases and nasty nerve problems that need more invasive treatment like surgery. Fortunately most sciatica problems respond well without surgery. Manual therapy, like manipulation, as well as acupuncture feature have been shown to be effective.

How you choose to be treated for sciatica will often depend on your personal preferences. Some people hate the idea of acupuncture needles. For others manipulation or drug treatments are not appealing. Fortunately there are many treatment options and usually a combination of the most effective ones should be tried first. This means consulting a practitioner who is happy to work as part of a team to get the best outcome. Here at Sundial we have chiropractors, physiotherapists and acupuncturists who work with the recommendations from your GP. For more information on back and leg pain go here.

Surgery for sciatica is usually only contemplated for patients with severe nerve compression, if symptoms don’t respond to conservative care or carry on getting worse in spite of treatment.

Reference

Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses.
Lewis RA et al. Spine J. 2015 Jun 1;15(6):1461-77.

Richard helps lead breakthrough in antibiotic treatment for back pain

Richard Hollis

Back pain treatment breakthroughs are rare. Yesterday the most important breakthrough in back pain care in a generation was announced.  It has been found that antibiotic treatment may hold the key for millions of back sufferers.

A top research team found that some chronic, long-standing back pain is caused by an infection.  The researchers estimated this accounts for up to 40% of long term back pain sufferers and could save the NHS millions of pounds a year.

Richard Hollis, chiropractor at Sundial Clinics in Brighton, also practices at London centre set up by the Danish research group who identified this condition. Richard is currently the only practitioner in Sussex certified to identify and help manage treatment for this new condition.

Peter Hamlyn, a consultant neurologist and spinal surgeon at University College London yesterday said “Make no mistake this is a turning point, a point where we will have to re-write the textbooks.” He added, “It is the stuff of Nobel prizes.”

Sundial chiropractor Richard said “These back pain sufferers typically didn’t respond to treatment and not only do we now know why, for most of these sufferers there is a cure”

Richard added “In years to come I expect this treatment, MAST, will become standard for people with Modic disease. We are talking about probably half of all spinal surgery for back pain being replaced by taking antibiotics which would save the NHS about £250m let alone the savings from decreased medication and time off work”.

For more information or to book an appointment to see if this new treatment can help you, ring Sundial Clinics on 01273 696414.

For information on certified clinicians and MAST treatment see here.

Reference


Back pain, will a chiropractor get it better?

If you go to see a chiropractor for back pain treatment in Brighton one of the important questions you want answered is “Will  a chiropractor help me get better?”  This is an important question for chiropractors too. If our treatment is not going to be effective we want to refer you quickly to another treatment.

This is a hot topic in the research at the moment. Back treatment studies are popping up all over the world trying to answer the question “who is likely to get better when they see a chiropractor for back pain?”

It is a hard question to answer because there are lots of different causes of back pain, people have different lifestyles, respond to care differently and some people don’t do their exercises!

So what are the results from these studies going back 25 years. Back sufferers who do worse tend to have more severe pain for a longer period. So far no surprises. People who have more than 30 days pain in the last year are more likely to carry on having pain. Being in work seems to help and curiously so does moderate alcohol consumption in more longstanding back pain.

Perhaps the most interesting findings are that your expectation of whether you will get better affects whether you will get better. If your clinician expects you to get better you are more likely to do well too. So being optimistic and being given a good prognosis help you get rid of back pain quickly.

Also if your back pain improves well in the first few treatment visits with a chiropractor then that means you are likely to have a better outcome. In fact if you have a recent bout of back pain between 60% and 80% of people are significantly better after 4 visits. These results are broadly similar for other conditions like neck pain, disc problems and whiplash.

28% of people will see a GP for back pain. And 10% of people now seek care from practitioners like chiropractors for back pain. In some areas chiropractic is available on the NHS but, sadly, not in Brighton.

Oh and one last thing. People did better if they felt that they got enough time with the chiropractor. So if you feel you would like more time at your next appointment just mention it when you book and we will happily give you a longer appointment at no extra fee.

If you haven’t been in before but would like to know if our physio’s or chiropractors in Brighton can help you then give us a call for free check. We’d love to see you.

References

Proceedings of College of Chiropractors Annual Conference, RCOG, London, Feb 1st 2012