22 Nov 2019

Non-Specific Lower Back Pain

Roughly eight out of 10 individuals suffer from bouts of back pain. In the majority of cases it isn’t due to any serious injuries or serious back problems, so the exact cause of pain isn’t clear. Common advice is to remain active and continue doing your normal activities as much as you can. In the majority of cases, the pain subsides within six weeks, but it might come back at one point or another. Non-specific lower back pain is the most common of all back pain. Roughly, 19 out of 20 cases of acute lower back pain are termed non-specific. This is the type of pain that the majority of individuals will have at one point in time or another. It is termed as non-specific due to its unusual nature in that no one knows what actually causes the pain. No specific disease or problem is associated with this pain. Non-specific lower back pain as a term has become common in recent times used by doctors, but some practitioners believe that back pain can be traced back to a cause or a pathology, hence the term is not used by all medical professionals. In many cases, if a more specific cause of pain is known, this will be attributed to the patient rather than the term “non-specific”.

Non-Specific Lower Back Pain Anatomy Understanding your spine and the manner in which it works will help you understand what is causing the pain in your lower back to begin with. Your spine is composed of multiple small bones (vertebrae), which are all stacked one on top of the other. Ligaments, muscles, intervertebral disks and nerves are the additional components of your spine. The bones of the vertebrae connect to form a canal protecting the spinal cord. The column is composed of three different sections creating three distinct curves in the back: the curves within the neck area (cervical), the lower back (lumbar) and the chest area (thoracic). The lower part of the spine (coccyx and sacrum) is composed of the vertebrae that are fused together. The electrical cables of the nerves and the spinal cord travel through the canal and carry messages between the muscles and the brain. Nerves branch out from the cord and through all of the openings in the vertebrae. The ligaments and muscles provide you with the stability and support your spine and upper part of the body needs. Strong ligaments are responsible for connecting the vertebrae and work to keep the spinal column in the proper position.

How to Treat Non-Specific Lower Back Pain:

  1. Exercise Continuing with normal activities is important. Even though it might not be possible at first, you want to do as much as you can. Don’t do anything that causes an intense amount of pain, but do whatever you can as quickly as you are able to.
  2. Therapy Physiotherapy, osteopathy and chiropractic is one of the most natural and common ways to treat non-specific lower back pain. The practitioners work in different ways using treatment techniques such as mobilisation (moving the joints), manipulation (moving the joints with high velocity to achieve a joint cavitation or pop in the joint), soft tissue massage techniques, electrotherapy, and exercise rehabilitation.
  3. Medication If you are in need of painkillers, it is best that you take them on a regular basis. Don’t just take them every now and then when the pain becomes severe. They can be useful when the pain is unmanageable. But it is generally advised to look for alternative ways to manage or treat your back pain.

Tips: • Set new goals every day for yourself. Walk around the house one day, walk down to the grocery store the next and so on. • Sleep in whatever position is the most comfortable for you. • Using a pillow between the knees while sleeping will help to ease symptoms at night • Don’t wait for complete pain relief before returning to work. Getting back to work quickly and back into your normal routine can improve your symptoms. • See your Rehab My Patient therapist as often as is required as they will help ease and reduce your back pain.

Piriformis Syndrome

Piriformis syndrome is a relatively uncommon neuromuscular disorder caused whenever the piriformis muscle causes the sciatic nerve to become compressed. The muscle is a pear-shaped muscle located near the top part of the hip joint in the buttocks. Piriformis literally means “pear-shaped muscle” and it is located in the middle of the buttock. It is an important component to lower body movement because it helps to stabilize the hip joint and rotates and lifts the thigh away from the body. It allows you to walk, maintain balance and shift weight from one leg to another. The muscle tends to be used quite frequently in sporting activities involving rotating and lifting the thighs. Essentially, the muscle is used for almost every movement involving the legs and hips. The sciatic nerve is a long, thick nerve in your body. It passes along the piriformis muscle, runs down the back of the leg and branches off into the smaller nerves ending in the feet. Compression of the nerves might be caused from spasms in the piriformis muscle. Whenever you suffer with back pain, there is a chance that the piriformis can go into spasm. The buttock muscles tighten up, and this can cause referred pain into the back of the leg and down to the foot. However, sometimes there is a genetic variation with the muscle and the sciatic nerve whereby the nerve actually pierces through the muscle, and this is thought to occur in 7% of the population and makes piriformis syndrome more likely. However, there is no way to accurately determine if this is the case in any particular patient. Piriformis syndrome is difficult to diagnose, and most commonly is diagnosed by case history by a doctor or therapist. Sometimes it is diagnosed after other more common causes of sciatica are ruled out, such as a disc prolapse (slipped disc). MRI scans do not tend to show piriformis syndrome, but they do show trapped nerves in the spine which may actually be causing the sciatica.

How to Treat Piriformis Syndrome:

  1. Rest Avoid those activities causing pain, whether that be sitting or actually moving around and doing something. Find a position that doesn’t cause a lot of pain.
  2. Ice Apply ice to the affected area for 5-10 minutes at a time three to five times per day. Make sure to wrap the ice in a thin towel to avoid an ice burn on the skin. Ice helps to alleviate inflammation and pain in the affected area.
  3. Physical Therapy The therapist might recommend that you go through a program of stretches and exercises to help reduce the compression on the sciatic nerve. As the compression levels decline, the pain in the area will begin to decline. Physical therapy is probably the most effective way to treat the condition. Your therapist will massage into the piriformis muscle using their fingers or commonly an elbow. If this replicates pain into the back of your leg, it is possible that you do actually have this condition.
  4. Acupuncture Acupuncture using a long needle into the belly of the piriformis can reduce sciatic pain and muscle spasm. It can be remarkably successful in stubborn cases of piriformis syndrome.
  5. Injections Cortico-steroid injections around the buttock may help reduce inflammation. Some people have also tried Botox injections to decrease pain.

Tips:  Before participating in any sporting activities, make sure you are properly warmed up.  Avoid running on any uneven surfaces or exercising on a hill unless you are more experienced.  Increase intensity slowly when participating in any exercise routine.  When exercising, running or walking, always use proper posture. If you are not sure, discuss with a sports coach.  If you notice pain when performing an activity, stop doing the activity until you notice the pain is no longer present in the affected area.  See a therapist and ask them to deeply massage the buttock. If you have piriformis syndrome you will often notice quite a significant improvement in symptoms.