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Back pain can be, well a real pain! An astonishing 80% of people are estimated to suffer from back pain in the UK every day. The question has to be ‘why?’.

To understand this problem we need an understanding of the back and its structure.

The back – a summary of the structure

The back (or in anatomical terms ‘spine’) contains 24 vertebra (bones), with shock absorbers between them called discs. A series of ligaments join each vertebra together and create stability, while tendons connect muscles together between the vertebra and create movement.

Inside the vertebra there is a canal which contains the spinal cord (made of nerves), through the spinal cord travel messages from the brain to the limbs. The messages are transferred from the spinal cord to the limbs. All these messages travel in nerves. Therefore there are a lot of nerves in the spine. Any treatment to the spine should therefore be extremely careful taking into consideration the risks associated with causing damage to these nerves. All our practitioners are fully qualified to ensure this does not happen.

The back – the structure of the back defines its function

The spine can be divided into three parts. The neck – or ‘cervical spine’, the mid back – or ‘thoracic spine and ribs’ and the low back – or ‘lumbar spine’.

The cervical, thoracic and lumbar spine each have a different role, which is specific to its morphology (or shape):

The cervical spine – enables orientation your head and your sense (eyes, ears and nose). Key function: mobility

The thoracic spine – the thoracic spine and ribs are termed the ‘thoracic cage’ because they offer a protective casing for our essential organs (heart and lungs). Key function: protection

The lumbar spine – bears the weight of our head; both our arms and our torso. It is incredibly strong. Key function: load-bearing

Due to the different functions of the cervical, thoracic and lumbar spine, there are specific issues which are specific to each area. We see patients in clinic who are complaining of pain in the cervical, thoracic and lumbar spine, and our clinicians are fully trained to treat issues in all three areas.

So, now we have an overview of the back and its structures let’s move on to answer some specific questions about the back.

Is my back pain due to my age?

In the region of around one third of patient’s over the age of forty who we see in clinic have already diagnosed themselves with pain due to ‘old age’. It is often shown, following the case history and examination that the symptoms of back pain are not simply due to ‘old age’.

It is the case that some conditions are more prevalent in older age groups, such as osteoarthritis. However we find that there are also a number of other symptoms present in these cases, which can be treated and made more comfortable. Examples of this include muscle spasm and hypercontracture (tight muscles), loss of flexibility and immobility of surrounding joints.

Why do I have back pain on my left side or right side?

Unilateral (or one sided pain) is typically caused by a number of factors:

Zygoapophyseal facet joint – The joints of the spine are called Zygoapophyseal (or facet joints for short). Since the role of the lumbar spine is weightbearing, these joints can come under strain easily due to excessive or uneven loading. The excessive loading will compress the joint and cause pain. Additionally, if the joint is loaded unevenly, this creates pressure in a specific part of the joint. This is called ‘facet syndrome’.

Rib – Due to the opening and closing action of ribs during breathing, they are in constant use. Ribs are attached at the back onto the joints of the spine, and at the front onto the breastbone. The ribs are joined to one another by connective tissues and also via the intercostal muscles.

The constant action of opening and closing puts the ribs at a potential disadvantage. For instance if your cough or sneeze and one of the joints is in an incorrect position, this can cause joint pain. It is also possible to tear or damage an intercostal muscle or the connective tissue.

Musclemuscles are designed to enable the various parts of body to move. If a specific part of the body (e.g. a joint) is less mobile, or a particular part of the body is heavier, it can cause a muscle to strain. Muscle strains are a very common cause of unilateral pain.

Another cause of muscle pain is hypercontracture in the muscle. If a muscle has shortened due to dysfunction in another part of the body; due to inadequate stretching; or just because it has not be used enough, it causes the muscle to tighten. When the muscle is then activated is causes muscle pain.

Other factors – there may be other factors causing your back pain including referred pain from your internal organs. If you are concerned about your back pain, please contact us; your G.P. or if you are particularly concerned, please go to Accident and Emergency.

Why do I have back pain when I wake up after sleeping?

Pain on waking can be due to various factors. In fact one of the questions we are asked most commonly by patient’s is ‘why am I sore and stiff in the morning? While pain in the morning can be caused by a variety of factors. It is commonly caused due to a specific musculoskeletal complaint or due to a systemic condition. These are discussed in details below.

Musculoskeletal pain – musculoskeletal is a posh term for muscles ‘musculo’ and the skeleton ‘skeletal’ or muscle and joint. Musculoskeletal pain is therefore generated by inflammation in the joints or muscles. Musculoskeletal pain tends to be in a specific place.

Some of this pain can be altered while some of it may be due to a degenerative condition such as osteoarthritis.

Systemic conditions – Some morning pain may be caused by things other than musculoskeletal causes. One of the most common causes on morning pain, other than musculoskeletal, is Fibromyalgia. The condition fibromyalgia is not only characterised by widespread (multifocal) pain but also is commonly accompanied by one or more of a number of symptoms including: stiffness, fatigue, sleep, irritable bowel syndrome; memory loss; mood issues; dizziness; anxiety and depression.

We are commonly asked if we can help Fibromyalgia. The answer is ‘yes’, osteopaths can treat Fibromyalgia. While osteopaths cannot help treat all symptoms of fibromyalgia, osteopathy can treat the musculoskeletal components in this complex condition.

Why do I have back pain on my period / menstruation?

The symptom of pain is created due to a number of stimuli. These stimuli reach the brain via the nerves. If a nerve in the abdomen is stimulated (due to a contraction for example), it sends a message to the brain, which is sometimes interpreted as coming from the back. This is known as referred pain. Referred pain in the back can feel dull, whilst there can also be simultaneous pain in the abdomen, commonly described as dragging pain; pulling pain or heavy pain.

Why do I have back pain when I lay down?

Posture is created by a series of components including muscles, joints and connective tissue creating a functional structure. Muscles add structure to this When you relax, muscles which have been contracted due to protecting the underlying dysfunction, relax. This typically happens when you lie down. After the muscles relax and no longer continue to protect the underlying issue Therefore it can be the case that when you lie down.

Multifactorial, chronic and complex pain

Some of the patient’s we see in clinic have had chronic pain for decades. These cases are often multifactorial (involving a number of different elements) which combine to form a dysfunction. Complex pain cases such as these are something that the clinic has become known for. If you have a complex case, we aim to give you some outline information as to how we may manage your case accordingly. Below is a list of considerations which your practitioner will include when you come to the clinic:

  1. Where is your back pain coming from?

In order to ensure that the pain is from a musculoskeletal source and therefore can be treated by your clinician, other sources of pain will need to be ruled out. These include:

  • Neoplastic – e.g caused by a growth
  • Autoimmune – caused by your body’s disproportionate reaction to a stimulus
  • Traumatic – e.g. fracture; fall
  • Iatrogenic – due to a reaction from medication
  • Metabolic – e.g. when your body’s muscles don’t have enough energy
  • Infective – e.g caused by an infection
  • Congenital – predisposed by a family history or complaint starting prior to birth
  • Degenerative – due to wear and tear on the body
  • Referred – pain felt in the body originating from somewhere else
  • Inflammatory – e.g. the pain caused when the body aches when you have flu
  1. Is the pain from the musculoskeletal system or elsewhere?

It is important to ensure first and foremost that you are safe to treat. As osteopaths we are primary care practitioners, meaning that we actively diagnose and refer cases. As part of our care package we need to ensure that the underlying cause for your pain is not referred from your organ systems including gynaecological, urogenital, gastrointestinal, hepatic, endocrinological or cardiac. This will be discussed as part of your case history.

  1. Examination and treatment

Following you case history and once we are happy that you are safe to treat, we will formulate a specific examination and discuss a specialised treatment plan for you. This plan will be absolutely tailored to your needs.

  1. Prognosis

We expect your symptoms to improve and for your pain to decrease. If at any point your pain worsens or is accompanied by any other symptoms, please let your practitioner know.

The osteopaths at Somerset Osteopathic Clinic are qualified to ensure that your pain is treated safely. We work as an integrated team to ensure all the factors in your case are closely managed to relieve you from pain. For more information on how we can help, why not have a look at some of our other articles or book an appointment.

Ed Cossart

Ed Cossart

Ed is the Clinic Director and an Osteopath. He gained a first-class applied masters degree in osteopathy from the world-renowned European School of Osteopathy.