The Lumbar Spine is an intricate structure of bones (5 vertebrae, numbered L1 - L5) the sacrum, coccyx, muscles, ligaments, tendons and a highly sensitive nerve and vascular supply.
Even though incidents of lumbago and sciatica are recorded as far back as Hippocrates, for the majority of patients the true cause of lower back pain remains a mystery. Such ambiguity is a direct reflection of the complex anatomy of the spine, where there are many pain producing soft tissues, including the articular joints, corresponding nerves, ligaments and muscles. Despite this complexity, lower back pain can be divided into several recognised categories:
- Lower Back Muscular Sprain/Strain
- Facet (Zygapophysial) Joint Pain (Dysfunction)
- Spinal Stenosis
- Slipped (Prolapse) Disc
- Sacroiliac Dysfunction Back pain can be caused by: Lifting, pushing and pulling incorrectly, sitting for long periods (e.g. driving), improper sitting (slouching), repetitive movements, overuse in sports, bending incorrectly, trauma, wear and tear of joints (osteoarthritis).
Sometimes back pain can occur without any apparent mechanism of injury
Symptoms of lower back pain
Depending on the cause and structure involved, there can be many different symptoms for lower back pain:
- Pain and stiffness in the back
- Referred pain in the buttocks and the legs
- Pain that worsens when bending, stretching, coughing, or sneezing
- Tingling, weakness or numbness that radiates from the lower back and into the buttocks and legs – especially with activity
- Activities such as walking, twisting and bending may increase the pain
- Other symptoms include a ‘pins and needles’ sensation, or tingling and difficulty moving or controlling the leg
- Typically, symptoms only manifest on one side of the body.
There are many different conditions that can cause back pain, so a thorough medical history is performed as part of the examination. Important questions are asked to ascertain the source of the pain, and then a physical examination will be performed.
Additional diagnostic tests for lower back pain include:
X-ray – Provides information on the bones in the spine; used to test for spinal instability, tumors and fractures.
MRI scan – Displays a detailed cross-section of the components of the spine.
Paracetamol is effective in treating most cases of back pain. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.
If muscle spasms are present, a short course of a muscle relaxant, such as diazepam, can be taken. Some people find that non-sterodial anti-inflammatory drugs (NSAIDS), such as ibuprofen, are more effective.
Physical therapy such as physiotherapy, osteopathy and chiropractic treatment can help with back pain. These treatments involve exercises, posture advice, massage and techniques known as spinal mobilisation and spinal manipulation.
Injections for lower back pain
Injections can help to deliver medicines (local anaesthetic and anti-inflammatories) directly to the source of pain, so it is possible to progress with physiotherapy or other rehabilitation.
There are four injection techniques available for lower back pain:
- Caudal Epidural Injection. This targets the space that surrounds the spinal cord.
- Sacroiliac Joint Injection. These injections target the sacroiliac joint
- Facet (Zygapophysial) Joint Injection. These target the joints that link the bones of your spine.
- Nerve Root Block Injection (also known as Pararadicular Injection). This targets individual nerves in the spine.All injections are performed using Ultrasound Imaging.
Advantages of Ultrasound Injection versus Fluoroscopy:
- No exposure to Ionizing Radiation
- Real-time needle guidance
- Direct visualization of the target of interest
- Shortens procedure time
The old proverb is true; “Prevention is better than cure”. And this philosophy is never more apt than when applying it to your own personal health.
The Health Promotion & Preventive Medicine service aims to promote and maintain good health and well-being, prevent disease and reduce the chance of disability. This service combines public health skills with knowledge of primary, secondary and tertiary care prevention strategies.
Disease prevention involves specific interventions aimed at avoiding contact with the disease and decreasing risk factors for disease. Where this is not possible, we use treatments to minimise any harmful consequences of the disease process.
Health screening is a major component of this service and involves routine testing to see if you are at risk of developing future health problems.
Knowledge is power, and thus our goal is to educate patients about their own health. We try to clearly communicate accurate, useful, health-related information to patients. Empowering patients in this way is crucial to help them make the right health choices and improve their overall wellbeing.
We focus on six main areas of disease:
- Cardiovascular Diseases (heart attacks and stroke etc.)
- Respiratory Diseases (e.g. chronic obstructed pulmonary)
- Obesity and Weight Management
- Mental Health
A major determinant of your wellbeing is the amount of knowledge you have about health issues, but also your attitude and desire to bring about positive change in your life.
Compartment Pressure Testing is the ‘Gold Standard’ for diagnosing Chronic Exertional Compartment Syndrome [CECS].
The test involves inserting a small catheter, under local anaesthetic, into one of the four well-recognized compartments of the lower leg. (Anterior, Lateral, Deep Posterior and Superficial Posterior) When the catheter is in place, the patient is then asked to run until they experience the pain. The pressure is then again measured post exercise.
The key benefit of Compartment Pressure Testing is the role it plays in diagnosing Chronic Extertional Compartment Syndrome (CECS), which makes it a vitally useful tool for athletes and runners.
Chronic Extertional Compartment Syndrome
Chronic Exertional Compartment Syndrome is a condition that can be caused by exercise. Repetitive movements, such as running, can induce high pressure within a closed space, which results in decrease tissue perfusion. This causes symptoms such as pain, cramping, burning, tightness and weakness of the effected lower limb.
There are four key factors believed to contribute to an increase in compartment pressure:
- Inelasticity of the fascial sheath
- Increase in volume of skeletal muscle secondary to blood volume and oedema
- Muscle hypertrophy (enlargement) in response to exercise
- Dynamic contraction factors due to demands in the gait cycle.
Compartment Pressure Testing is an incredibly useful diagnostic tool to exclude other causes of exercise-induced leg pain such as stress fractures, periostitis (inflammation of band of tissues that surround bones), Medial Tibial Stress Syndrome various tendinopathies, neurological compression syndromes and infection.
When the catheter is in place, the patient is then asked to run until they experience the pain.
The pressure is then again measured post exercise.
Extracorporeal Shock Wave Therapy (ESWT) is used to treat a variety of musculoskeletal and orthopaedic conditions through the use of shock waves. This is a non-invasive, non-surgical treatment and is incredibly effective in treating chronic pain, inflammation and large range of other joint, bone and muscle injuries and illnesses.
ESWT uses shockwaves to stimulate healing. It offers advantages over surgery as it is non-invasive with fewer potential complications and a faster return to normal activity.
Three treatments are performed at weekly intervals. Each treatment is simple with no injections. Your affected area is positioned against the head of the ESWT machine and a shockwave is delivered to the area. This is felt as a pulse.
Conditions commonly treated by ESWT include:
- Heel Pain / Plantar Fasciitis
- Shoulder Pain
- Tennis and Golfer's Elbow
- Achilles Pain
- Hip Pain
- Jumper's Knee Patella Tendonitis
- Shin Splints
- Neck and Lower Back Pain (Trigger Points)
Traumeel is a biotherapeutic medication which uses a concoction of natural ingredients that targets inflammation in the body and promotes healing in a balanced way.
Benefits of Traumeel
Traumeel is a fantastic treatment option if you are suffering from an injury such as ligament tears, sprains, contusions, post-traumatic swelling and other soft tissue injuries. By targeting excessive inflammation in the body, Traumeel can reduce painful symptoms and get you active again quicker than conventional anti-inflammatory drugs – without any adverse effects.
Biopuncture is an injection system using biotheraputics and has its origins in acupuncture, neuraltherapy and homotoxicology. Specific areas of the body are injected with biologically active substances, which will help to reduce symptoms and speed up recovery.
Benefits of Biopuncture
Neck pain, back pain, sciatica and sprained joints all respond well to this treatment. The safe and effective treatment stimulates the self-healing capabilities of the body and helps to eliminate symptoms.
As opposed to conventional drug treatments, the low doses of substances that are injected during Biopuncture wake up the body’s own healing responses rather than instantly repressing symptoms. This means that the healing is coming from within, which is a much more beneficial option.
Lipogems is a game changing regenerative medicine therapy that can be used to treat a wide range of orthopaedic conditions. Learn more
Platelet rich plasma is an innovative treatment in sports and orthopaedic medicine, PRP uses your own blood for healing muscle, tendon and ligament injuries. Learn more