Back Pain

Osteoarthritis in the spine (mid or lower back pain)

Osteoarthritis is the process of degeneration of the joints which occurs over time and leads to wearing down of the joint surfaces. The process can start earlier in some people. Common symptoms include stiffness and pain.

Physiotherapy can help by setting exercises to increase the strength around the joints and improving your flexibility. Clinical Pilates is a safe effective form of exercise to help this condition. Acupuncture for pain relief and manual treatment to improve stiffness and reduce pain can also be helpful. The physiotherapist can all advise you on cushioning footwear and advise on aerobic exercise which will help keep you fit but put minimum stress on your back. Keeping your weight under control will also help reduce stress on your back.

Sciatica

This is when the sciatic nerve exiting from the spine is compressed and leads to a severe, often sharp, throbbing or burning pain down the back of the legs. Sometimes pins and needles, weakness or numbness in the legs can also be felt.

Physiotherapy treatments that can help include exercises, massage, advice, manual therapy and acupuncture. Clinical Pilates is a safe effective form of exercise to help this condition.

Lumbar spondylosis (lower back pain)

This condition normally does not present until later in life. It occurs by the discs in the spine reducing in height and this can lead to degeneration of the joints in the spine and sometimes affect the nerves that exit from the spine. Typical symptoms include a dull ache in your lower back. This ache can occasionally extend to your buttocks, groin and outside of the hip. Sometimes your legs can feel like they lock or give way and there can be a loss of feeling or needles and tingling felt in the legs.

Physiotherapy can help to reduce the pain and any tingling symptoms. Exercises and manual therapy can be used to increase your flexibility and strength of the muscles around the lower back and improve your posture. Acupuncture and taping can also be beneficial to help reduce the aching pain. Clinical Pilates is a safe effective form of exercise to help this condition.

Spondylolisthesis (lower back pain)

This condition involves a defect or break in the vertebra itself and the vertebra can slightly move backwards on the vertebra below. There are several different types including being born with it, developing it over time from doing a repetitive sport, developing over time with age or from a traumatic incident. Symptoms normally include low back and buttock pain. Sometimes the pain can progress down the leg. The pain is often made worse by activities that involve being upright or leaning backwards and bending forwards often improves the pain.

Physiotherapy techniques that can help improve the pain and stiffness include advice, manual therapy, massage, exercises and acupuncture.

Stenosis (lower back pain)

This condition most commonly affects the lower back (lumbar vertebrae). It mostly occurs in people over the age of 60. Certain processes lead to a decrease in the size of the area where the sciatic nerve exits out of the spine. The sciatic nerve exits from the spine and passes down the back of both legs. Most commonly leg pain felt will be worse than the back pain. There can be tingling and weakness in the legs often made worse by standing or walking. The symptoms often become less when sitting and the pain on walking downhill is worse than walking uphill.

Physiotherapy techniques that can help include advice, manual therapy, taping, strengthening around the lower back and acupuncture. Clinical Pilates is a good form of exercise to help this condition.

Locked back (mid or lower back pain)

This is when a piece of soft tissue (meniscus) becomes trapped within a joint within the back and leads to pain and the back being locked. The pain is usually located to one area and rarely will extend into the buttocks or thigh. There may be spasm and pain in the muscles in response to protecting the back.

Physiotherapy treatments that can help include manual therapy, massage, exercise, advice, taping and acupuncture.

Muscle spasm

There are many muscles around the spine. These can be strained, torn or just become in spasm trying to protect the spine. Trigger points can develop in muscles in spasm. These are specific tender spots that develop that give rise to pain and can also cause pain in other areas of the body.

Physiotherapy treatment can work directly on these muscles to release the trigger points and muscle spasm. Exercises can be set to strengthen weak muscles and increase flexibility of tight muscles to prevent the spasm from returning. Underlying joints in the spine may be stiff contributing to the problem and physiotherapy treatments can work directly on these stiff joints. Acupuncture and taping are also useful treatments. Clinical pilates is a safe effective form of exercise to help this condition

Proplapsed disc (mid or lower back pain)

This is when one of the discs slightly bulges. It can happen over time or suddenly as a result of a sudden movement or accident. The pain is normally quite deep and achey. Sometimes activities such as coughing, sneezing or bending forwards can make the pain worse. If the bulge of the disc causes pressure on the nerve exiting the spine then there can be leg pain or pins and loss of feeling/tingling also.

Physiotherapy treatments that can help include manual therapy, massage, exercise, advice and acupuncture. It is important to strengthen the muscles that stabilize and support the spine. Clinical pilates is a safe effective form of exercise for this condition.

Instability (mid or lower back pain)

Stability of the spine comes from the spine itself (joints and ligaments), the muscles around and attached to the spine and responses from the nerves and brain. Symptoms of the spine not being as stable are asense of the back giving way and feeling of a painful catch or lock.

Physiotherapy has been proved to help by working on retraining the strength of the muscles around the spine and the brain and nerves contribution to controlling the stability around the spine. Clinical pilates is a safe effective form of exercise for this condition.

Spondylosis (stress fracture in the lumbar spine)

This stress fracture usually occurs in the side opposite to the one performing the activity ie. left side fracture in right handed tennis players. The pain is usually felt on one side of the lower back and becomes worse with leaning back.

If suspected a medical referral will be made to a top London spinal surgeon who will investigate and advise appropriate treatment to allow full healing of the fracture. Once allowed physiotherapy can help to restore flexibility and strength around the spine. Clinical Pilates once allowed is a safe effective form of exercise to undertake.

Cauda equine syndrome

The causes of this condition include fracture, a tumor, infection, stenosis, prolapsed disc and trauma. Symptoms include low back pain, pain and weakness in the legs. Also the bladder and bowels are affected and numbness or reduced feeling around the anus and genitals. If symptoms are suspected immediate attention at A&E is required.

Intermittent claudication

This is caused by a blockage of the arteries in the legs most commonly the calf and foot. It commonly causes aching, tiredness and sometimes burning in the legs. Pain is usually becomes worse with exercise and improves with rest. This condition is not treatable with physiotherapy.

Osteoporosis

This is when the inner part of the vertebrae of the spine breaks down. This results in the bone becoming weaker and fragile therefore prone to fracture. It happens with age and is a lot more common in females. It is not normal to experience pain with osteoporosis unless a fracture is sustained. Fractures of the spine can cause a severe pain that refers from the back like a band around to the sides. Over time there can be a number of these fractures that lead to more constant long term lower back pain. As the insides of the bones collapse it can lead to a hunch liked appearance of the upper back as the spine curves.

Physiocomestoyou has devised a specific programme for people suffering with osteoporosis to help improve their posture and strengthen the body to reduce the impact of osteoporosis. Refer to our osteoporosis programmes.

Ankylosing Spondylitis

The cause of AS is unknown and it is a condition that causes inflammation of fibrous tissue and becomes worse with time. In the early stages symptoms include on and off back pain that is relieved with activity/exercise and stiffness in the neck. The joints of the pelvis often become inflamed and painful. In the later stages of AS the low back pain can become more constant and fusion of the joints of the spine and pelvis can occur leading to reduced movement in these areas. Sometimes pain in the hips, knees and shoulders can also occur. It is more common in males under 40 years of age and usually worse in the morning. Some people with AS can just become stiff and pain is not a problem.

Physiotherapy can help with pain relief and providing an exercise programme to help maintain movement in your joints and strengthen any weakened surrounding muscles. They can advise on appropriate aerobic exercise you can take part in to keep fit without aggravating your pain. Clinical pilates is a safe effective form of exercise to help this condition.

Referral of pain from other areas of the body

Pain can be felt in the back that actually is being referred from another area in the body such as the hip, pelvis or other internal organs such as the stomach, liver, gall bladder. From taking an extensive history when assessing the client physiotherapists can help to determine whether your back pain is in fact coming from elsewhere. Then appropriate treatment can take place.

Rheumatoid Arthritis

Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment that includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

  • Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
  • Wheelchair assessments
  • splinting

Fibromyalgia

This condition does not involve inflammation but affects the fibrous tissues in many parts of the body ie. tendons, muscles, connective tissue etc. There can be a large number of tender points and a feel of generalized aching. One of the common tender points is on the inside of the knee. There a number of other symptoms including fatigue, sleep disturbances, sensitivity to temperature, morning stiffness, numbness and tingling, irritable bowel, depression and dry eyes and mouth.

Physiotherapy can help people with this condition. There are pain relieving techniques that can be used and they are experienced in pacing you back to being able to exercise again and return to activities whether sport, work or hobbies that you were able to do before the condition started. They also are able to provide advice on how to cope with your condition and manage flare ups of pain.

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants to help you.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

  • cardiovascular symptoms
  • respiratory (breathing) symptoms
  • gynaecological symptoms
  • urinary or genital symptoms
  • digestive symptoms
  • immune system symptoms
  • lymph system symptoms
  • hormonal symptoms
  • neurological symptoms
  • dermatological (skin) symptoms
  • medication side-effects
  • virus
  • infection
  • cancer
  • disease process
  • psychological problem ie. depression, anxiety