When you take a poorly baby to a doctor and they cry constantly, you might hear the doctor mutter how much they like noisy babies.
It’s not the doctor being insensitive or sarcastic, it’s because babies who are red-faced and screaming are rarely the ones that need serious medical attention.
When it comes to back pain, the pain itself is not necessarily the most important feature.
Toby Pollard-Smith, a registered osteopath and co-founder of BackPain.online, shares three areas which are regularly considered in cases of back pain. And they’re not all to do with the pain.
First, Electrical Faults
Our nervous system is our electrics. Our brain is a control unit, and we have nerves throughout our body that bring signals in and send instructions out.
The main bundle of cables that leaves our brain is housed in our spinal cord. The bones of our spine protect this cord from damage, but unfortunately, it’s not foolproof.
There are various things that can happen in or around the base of our spine that can cause compromise of our nerves. This includes disc injuries (such as a bulge, herniation or protrusion), but can also be due to changes to the joints of the spine, or other growths such as cysts.
When nerves become compromised they can be painful. Such pains are typically down the back of the leg to the foot, sometimes down the front of the leg to the knee, or sometimes around the pelvis towards your groin.
Pain on its own isn’t a huge concern clinically – sorry.
What is more important is any loss of nerve function.
- Sensation might be altered, causing pins and needles perhaps, or feeling can be lost completely resulting in numbness.
- The instructions being sent to your muscles can also be affected, causing twitching (fasciculations) or weakness, even as far as paralysis.
It’s the last of these factors, weakness, that causes concern if it affects your legs and feet. When we assess someone and find this weakness, we have to watch carefully to see if the weakness gets worse. If it does, it’s one of the reasons we would look at getting imaging taken and perhaps asking a surgeon’s opinion. The good news is that most cases get better without such intervention, but it’s important that they are monitored.
Next, when the electrics affect the plumbing
Luckily, the wiring pattern for human beings is standardised. The bundle of nerves that is encased within our spinal column has branches that leave between each pair of vertebrae. These are numbered and called nerve roots. The areas that are controlled and sensation felt by each root are embedded in the brains of all manual therapists.
Your legs are looked after by L2 and L3 on the front, and L4 and L5 below your knee, as well as by the next root, S1 on the sole of your foot and then up the back of your leg. By the time you get to your buttocks, it’s over to S2, S3, S4, S5.
You might not think that there’s as much happening here, and you’re correct on the surface – literally and figuratively. What’s important is what those nerves S2 to S5 are doing on the inside. They’re not controlling the muscles we need to walk, but instead, have responsibilities for our bowels, our bladder, and our reproductive anatomy.
So when the function of these nerves is compromised, it affects whether we can control our bowels and bladder. It can cause accidents with our bowels when they empty without warning, and the opposite with our bladder, resulting in an inability to pass water. Patients who are experiencing such problems will also find themselves numb between their legs, and up to their anus.
When this happens, we don’t have the luxury of waiting a little while to see how things pass. It is much more important that these cases, named cauda equina syndrome after the area of nerves responsible, are taken seriously and medical help requested. Imaging is needed in the first instance to quickly assess precisely what is causing the symptoms. If there is anything physically compressing the nerves, action is required before the symptoms become permanent
Last, the lack of a pattern
The last area to consider is non-mechanical pain. Quite simply, when there is constant pain in absence of movement, questions need to be asked.
A sudden onset of pain that occurred doing a particular movement is good evidence of pain being mechanical. Knowing that certain movements hurt while others don’t also helps.
But when patients say that their pain is constant, regardless of what position they’re in, then it starts to sound like the pain is being caused by something else.
Sadly, the list of causes isn’t pleasant reading. It can be cancer, or other benign growths. Lower back pain can also be related to bowels or bladder, whilea little higher up the back, it can be kidneys and ureters. Infections can cause pain and vascular conditions such as an abdominal aortic aneurysm can also be causes of back pain.
When these are suspected, they need to be investigated by your doctor, not treated by a manual therapist.
In conclusion
As ever with such matters, most of the cases we see are very benign, with good prognostic indicators of recovery. But we have to be receptiveto our patients and not jump to conclusions. The best advice we can give to patients is to go see an expert when you’re worried. It’s not for you to know the details of everything above, so find someone you trust, and follow their guidance