Back Pain and Sciatica
Have you been experiencing back pain and sciatica after bending down or picking up a heavy object?
Maybe you’ve got a shooting pain or nasty ache down your leg that’s keeping you awake at night?
Perhaps you’ve done some physiotherapy, osteopathy, or seen a chiropractor, but your symptoms still aren’t getting better?
Don’t struggle on, there’s lots that we can do. Many people who I meet in clinic with back pain or sciatica (pain going down your leg or into your buttock) have been struggling on for some time, when back pain and nerve pain is a very treatable.
What causes my back pain?
You may be wondering, what is causing your low back pain? Many people will experience pain that’s in the lower back area and this is a very common problem that almost all of us are going to experience at some point in our lives.
However, sometimes it goes on to become an issue that prevents us from being active, playing with our kids, or even be able to work. The lumbar spine is a complex mix of vertebrae, discs and small joints called facet joints, and over the years, our understanding of low back pain has changed.
In very simple terms, you may have read about the concept of a slipped disc, which is really a bulging disc that may impinge against a nerve root and give us pain down the leg, which we call in lay terms, ‘sciatica’. The reality is that back pain is something that can be triggered by an e.g. ‘event’ that happened to one of the discs, but often there can be changes or adaptations in the spinal cord and the nervous system that are essentially giving us wrong signals.
Sometimes then we develop behaviours around this. For example, we might not want to bend forwards or touch our toes, or we feel it’s wrong or ‘unsafe’ to move or load our backs.
Back pain is an emotional experience – as are all types of pain, and so it’s over-simplified to say that it’s generated by a sore joint or a pinched nerve.
Can I say a huge thank you to you – you are the most supportive & caring medic I have ever met. It’s rare to find these qualities, particularly in one so knowledgeable as you. I recommend you to anyone that will listen to me! This meant completely genuinely as you have been a tower of strength to me during my many problems over the past few years.
How is back pain or sciatica assessed?
When you come to clinic, I’ll talk with you about the symptoms you’ve been experiencing. For example, is it in your low back, does it refer into your leg? Does it affect your sleep? And are there any, what we call ‘red flags’ such as weight loss or night sweats that may point to a more sinister cause of back pain? Thankfully, these cases are very rare.
I’ll examine you, watch you move, carry out some clinical tests to see how you are moving or what else might be impacting the way that you move, for example, very stiff hips. We’ll talk about how the pain is affecting you and what treatments you may have tried so far.
Sometimes we’ll want to carry out some investigations, such as an MRI of your lumbar spine.
What treatments are available for back pain and sciatica?
Thankfully, the vast majority of people will improve with physiotherapy or osteopathy and a little education around pain and the behaviours we have when in pain.
Sometimes it might be necessary to consider interventions such as caudal epidural, foraminal root, or facet joint injections. I work very closely with my spinal pain colleagues when that’s absolutely necessary. It’s extremely rare that I would ever need to refer somebody for surgery for their back issue.
Sometimes when a patient is really suffering with back pain, I may involve a pain intervention specialist, a pain physio, and a pain psychologist in your care. The am is for you to understand your pain and to begin to build confidence, get moving better, and progressing on with returning to your favourite activities.
There are many myths around back pain such as moving or bending could be dangerous, that the individual structures are entirely responsible for the experience of pain, and that back pain cannot be changed.
Equally when we carry out MRI imaging, and we look at the images, we must put this all in the context of normal changes we’d expect to see in an aging spine.
Many people who have no back pain will have so-called abnormal changes on an MRI. The great news is that with a multidisciplinary approach, working with expert therapists, we can help you to overcome your pain and get active again.