Focus on Low Back Pain

 The Western world has seen a seismic shift in working patterns since the WWII such that the population is now far more sedentary throughout the day – commuting by car, sitting at work, consuming an energy rich (sugar & fat) diet, with evenings on the sofa watching TV. We are well aware of the consequences – obesity, metabolic syndrome and the like. However this physical inactivity also leads to poor muscular conditioning and poor posture, a consequence of which is increased load on the lumbar spine manifesting in many people with back pain.

Back Pain, along with Stress, accounts for a staggering amount of days lost from work in the adult population, but regular physical exercise can counter both. Simple interventions, such as standing workstations, have been shown to improve metabolic markers, and will also improve the tone of the postural muscles. Have you considered leading by example, and installing standing workstations in your own General Practice?

Low back pain can begin as a purely muscular phenomenon. Poorly conditioned muscles cannot hold posture for prolonged periods, which in turn leads to local fatigue. Imagine if you were asked to hold a weight out in front of you, and not put it down. It wouldn’t be long before your arm started to ache! Now imagine if you were asked to do this over and over again. Eventually the muscles form localized areas of cramp, so called myofascial ‘trigger points’. These can be temporarily eased with massage and manipulation, but if the underlying poor conditioning of the lumbar spine is not addressed, back pain can become chronic. Increased loading of the lumbar spine then leads to accelerated degeneration and worsening of pain.

Unfortunately compliance with therapeutic exercise for the back can often be very poor. Reasons include lack of time, motivation, belief in efficacy, or pain inhibition. Where pain prevents a patient from engaging in rehabilitation, a carefully delivered steroid injection can be very useful.

With advancing age, or trauma, degenerative changes will be seen in the Lumbar Spine on the MRI’s of most people. As such imaging can often cause confusion, rather than clarity. Disc Degeneration, MODIC change, Annular tears, Facet joint arthrosis, and disc prolapses are closely linked to back pain and sciatica, but these changes are seen in people without back pain too. Thus in an individual the root causes of mechanical back pain can be a diagnostic challenge.

Dr Creaney uses a combination of clinical assessment, imaging and image-guided (fluoroscopic) injections to investigate and treat patients with, so called, ‘mechanical back pain’ and ‘sciatica’. Please refer patients who would benefit from this approach in combination with a physiotherapy programme.