Simple back pain

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Spondylitis/spondylosis, disc disease and postural syndrome can all drive back pain complaints in the lower and mid back

The term simple back pain is used to describe this type of back ache once the more serious causes have been ruled out.  Conditions like cancer, abdominal aneurysm, kidney stones etc. can all present as back pain, so it is important to first consider them as possibilities, which is why a careful history and examination are essential.

Once the patient has been simplified to this ‘safe to treat’ category it is not easy to pin down just joint strain, disc pain or muscle strain because all three are usually present to some extent.

Spondylitis is just degeneration of the spinal joints which can be seen on x-ray.  Every vertebrae has 4 articular joint surfaces, so if you consider that there are 5 lumbar vertebrae, that means 20 potential bony sources of pain.  The whole vertebrae can show signs of degeneration, but it is generally where the movement occurs in these joints that we think pain emanates.

The same is true of the discs.  These are firm cartilage like structures in between each vertebrae, but they have enough ‘give’ in them to allow some movement.  These intervertebral discs are softer in the centre (especially in the younger years), which helps with shock absorption.  Unfortunately, the outer rim of these discs tends to crack and stretch out over the years, which leads to disc bulges and instability.  The nerve endings in these outer rim portions of the discs can be a tremendous source of pain when disturbed.

Postural syndrome relates to pain that can be improved by correcting posture, either immediately, or over a relatively short period of time.  Pain is felt more so in the muscles, and pain in the hips and gluteal muscles can often accompany the lower back pain.

Treatment of these types of simple backache problems needs to be individualised as some cases are very irritable and will only tolerate gentle treatments, while others require a heavy hand to get the job done.  Heat, soft tissue massage and dry needling are typically used, and there is usually some joint manipulation.  Core stability exercises are important as well, so we will teach the relevant ones if they are not already being done.

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