Understanding Back Pain: Identifying the Causes and Finding Relief

Understanding Back Pain: Identifying the Causes and Finding Relief

Have you been experiencing back pain? It is crucial to identify the cause of your back pain to determine if it is serious or not. According to Dr. Stuart McGill, a leading back professor, there is always a cause for back pain, and the pain is often aggravated by specific motions, postures, and loads. By identifying these patterns, you can take a big step closer to curing your back pain.

If you notice any red flags such as unexplained weight loss, fever, or pain that worsens at night, seek medical attention immediately. However, muscle pain tends to be unilateral and causes spasms around the affected area, while disc pain is commonly aggravated by sitting down for too long and bending down to pick up objects. It can cause referral pain down to lower limbs depending on which disc is irritated.

WHAT CAN A DOCTOR OR PHYSIO DO FOR CHRONIC BACK PAIN?

While medication may be part of a broader approach, passive treatments such as prescriptions for pain medication, or a modality such as ultrasound, without a plan to stop the cause itself rarely creates a long-term solution. In all cases, a typical 15-20 minutes appointment is not sufficient to diagnose back pain, and the person has no guidance as to what is required to build a foundation for pain-free movement.

HOW DO I KNOW IF MY BACK IS MUSCLE OR DISC?

Your back is subjected to various strong forces throughout the day, such as from twisting, sudden jolts, or poor posture when sitting hunched over. Any of your spine’s many interconnected and overlapping structures are capable of becoming injured and producing back pain. Common anatomical causes of back pain include –

• Large muscles that support the spine

• Spinal nerves that exit the spinal canal and may go to the legs or elsewhere

• Facet joints that connect the vertebrae along the back of the spine

• Intervertebral discs that provide shock-absorption for the bones

Muscle pain tends to be unilateral and causes spasms around the affected area and is usually more localised. It is usually aggravated by certain movements i.e. sit to stand, walking.

Whereas disc pain is commonly aggravated by sitting down for too long and bending down to pick up objects. Commonly this is less localised and can cause referral down to lower limbs depending on which disc is irritated.

However back pain can commonly affect multiple structures at once therefore back pain has a wide range of scaling of pain and each is different and is case by case dependent. Therefore there is no one size fits all.

But what can be done?

You can establish Motions, postures or loads that exacerbate the back pain together with those that are tolerated can be identified through a series of simple diagnostic tests.

A simple test you can do at home to find the pain triggers according to Dr. Stuart McGill.

1. The Sitting Compression Test

It is a simple test that can indicate how certain postures outside neutral can be exacerbating your pain. This will indicate positions to avoid completely until your pain settles and you can tolerate that posture pain free.

Start by sitting on a stool/chair with your arms by your side. Have a nice good posture with your spine in neutral. Pull the chair up (approximately 10kg) to add compression to the stacked spine.

1. Next slouch and repeat the compressive load. This will reveal if posture and spine curvature affects the pain. Many clients will be pain-free in the upright, stacked posture while the slouched will be uncomfortable. This reaction shows that flexed spine positions must be reduced when under load to reduce the pain sensitivity.

2. Repeat the same in an overarching position. If this causes pain then this will indicate a type of extension intolerance.

Summary of what each position can mean –

1. Neutral pain = Compression intolerant – When contraction of muscles is too much for your body so avoid any heavy lifting.

2. Stooped = Flexion intolerant – Avoid any bending movements (movements that bend the spine forwards).

3. Overarching = Extension intolerant – Avoid any movements that overarch the back and typically you can tolerate lying on your stomach.

Learning how to brace properly is a vital component in rehabilitating your long history of low back pain. The Abdominal Brace is a technique used to stiffen and stabilize the spine, preventing it from buckling and giving way under high load levels. Without proper muscle function to support the spine, the weight of the upper body would cause it to collapse.

It is essential to avoid any movements that aggravate your pain, and each case of back pain is different and is case by case dependent. By establishing movements, postures, or loads that exacerbate your back pain, you can work towards reducing pain sensitivity and rehabilitating your back to full health.

Check out my next blog post which we dive into further tests and treatments