Back Pain

Back pain is a common condition which affects many people of all ages. There are different types of back pain causing different symptoms and signs. Your back pain can be assessed and managed at Sportswise. This will include an assessment of the type of symptoms you are having, examination of your spine and discussion regarding the merits of further investigation. We can help to diagnose the type of back pain you have and explore treatment options with you.

Your Back

Your back consists of different structures including bones, muscles, ligaments, tendons and nerves.

The bones of the spine consist of blocks of bone called vertebra. There are 7 cervical vertebrae in the neck region, 12 thoracic vertebrae in the upper back and 5 lumbar vertebrae in the lower back. Below this is your sacrum and then coccyx.

In between each vertebra is an intervertebral disc which cushions the vertebra and allows your spine to move. The spine is supported by strong muscles and ligaments. Your spinal cord is a collection of nerves that pass down through the vertebrae with nerve branches spreading out to carry signals to control movement and sensation in your body.

Back Pain

Back pain is very common. 6-8 out of 10 people in the UK will experience back pain in their lifetime. In any one month period in the UK, up to 30% of adults over the age of 25 may have low back pain.

Chronic back pain is when you have back pain for more than six weeks and this occurs in about 1% of the population every year.

Types of Back Pain

There are different types of back pain:

Non-specific mechanical back pain - this is the commonest type where no serious cause is identified. This type of back pain can originate from soft tissues and vertebra, though it may be difficult to identify a specific cause. It involves back pain that can vary according to the posture, movement and mood.

A bulging intervertebral disc that is pressing on a spinal nerve can result in back pain with pain extending down one leg, also known as sciatica or radicular pain. This can also be associated with weakness and change in sensation in part of the leg.

Inflammatory conditions such as ankylosing spondylitis, where the body’s immune system produces inflammation in the spine, resulting in back pain and stiffness.

Certain sporting activities are associated with stress fractures in the spine and related to repeated extension (bending backwards) of the spine. If you participate in one of these sports then we may wish to exclude this with a scan (MRI and/or CT). Sports include cricket bowling, gymnastics, high jump, diving, tennis and other throwing events to name a few.

Less commonly back pain may be caused by a serious condition such as infection, cancer or other fractures.

Cauda equina syndrome. Though also uncommon, if this is suspected, it requires emergency medical review. It occurs when there is pressure on the nerves at the bottom of the spine. You should seek urgent medical review if you develop: altered sensation around the genital area, difficulty passing urine, incontinence of stool or difficulty using your legs.

Assessment and Diagnosis at Sportswise

At Sportswise, your back pain can be assessed and diagnosed by a Sport and Exercise Medicine consultant (doctor), a Pain Medicine consultant (doctor) or a physiotherapist.

During the assessment, your symptoms will be reviewed, looking at which factors may have led to the back pain, how your symptoms are affecting your life and whether there are any features of spinal conditions that require further investigation.

Your assessment will also include an examination of how your back is moving and may include an assessment of the movement and sensation in your legs.

Investigation

If you have non-specific mechanical low back pain, you may not require any tests such as scans.

However, if any clinical features are highlighted for further testing you may require an MRI (magnetic resonance imaging) scan and/or blood tests.

X-ray scans are not routinely used for back pain.

Management

We can help you to manage your back pain through a number of ways including:

Advice - Identification of why you have developed back pain and what factors are exacerbating the problem. This includes exploring physical and emotional factors that may be linked to your back pain e.g. prolonged sitting or standing, heavy lifting, pain with a particular sport/hobby, work problems, low mood and stress. If causative/exacerbating factors are identified, we can then advise you on how to manage these.

Activity - advising on the level of activity. In most cases of back pain, we would recommend that bed rest is not advised and you should stay as active as possible. Pacing of activities is essential in the long-term and we will help you understand how best to do this.

Exercises - A structured home exercise and stretching program, with ongoing guidance including physiotherapy review.

Physiotherapy - Within physiotherapy appointments, you may also benefit from manual (hands-on) therapy including massage or spinal manipulation.

Medication - Guidance on medication, with options including: non-steroidal anti-inflammatory medication alongside paracetamol, a short course of muscle relaxants and mild opioid medication for persistent pain. If you are getting symptoms related to the nerve irritation then you may benefit from nerve pain medication. We will discuss with you the benefits of each medicine and the potential risks helping you to decide the best approach. We will consider any medical conditions you have and the current medication you are taking to help reach the correct decision for you.

Acupuncture - Acupuncture and trigger point needling involves placing very fine needles in different parts around the body including the painful areas and also sometimes non-painful areas, in order to reduce pain and muscle tension.

Caudal Epidural Injection -This is an injection delivered into the lowest portion of the epidural space of your spine and may help symptoms by reducing inflammation/compression of spinal nerves. This injection can be carried out at Sportswise under ultrasound guidance.

Other Injections - the following injections would be carried out by our Pain Medicine doctor at the Esperance Hospital in Eastbourne:

Cervical Epidural injection – This is an injection delivered into the base of you neck and may help reduce inflammation and improve your arm symptoms.

Cervical facet injection – This is an injection/s delivered around the small joints in your neck to help improve your symptoms.

Lumbar facet injection – This is an injection/s delivered around the small joints of your low back to help improve your symptoms.

Lumbar Nerve Root injection – This is a specially targeted injection looking specifically at a single nerve that may be inflamed to help improve your leg symptoms.

Radiofrequency Denervation and Pulsed Radiofrequency treatments are special treatments that can prolong pain relief for patients suffering with pain of spinal origin.

MAST (Modic Antibiotic Spine Therapy) - If there is a particular pattern of bone swelling on MRI scan, termed Modic Type 1 changes, then you may benefit from MAST which involves taking long term antibiotic medication.

Referral – We have a network of other specialists e.g. spinal surgeons who can offer other treatment options where needed.

If you would like to make an appointment or have any questions please contact the administration team.
Telephone: 01323 745970 • E-Mail: reception@sportswise.org.uk