Back Pain &
Sciatica
Back Pain
Pain in the lower part of the back is commonly referred to as Lumbago. Back pain is very common, and can be severe and debilitating either in acute episodes, or as chronic pain suffered over a long period of time.
Low back pain is pain or discomfort felt in the low of the back to the upper buttock. It can radiate down the back of the legs, but essentially it rarely goes below the knee. I write this because quite often patients describe this pain as “sciatica”. Sciatica is very specific to the irritation of the sciatic nerve – please see the article sciatica.
Back problems account for the majority reason to visit Osteopaths.
Back pain is a very common problem, with reports suggesting as many as eight out of ten of us will suffer from it at some point during our lives.
The most common causes of back pain are strain and problems with back structure.
Common symptoms include:
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Dull aching sensation
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Sharp or shooting pain that radiates down the leg
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Decreased range of motion
Take-home advice
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Performing exercises to improve posture and strengthen back and abdominal muscles.
There are many causes of low back pain. We can’t list them all!
We will first need to take a detailed case history and do some tests. Among the list of more serious conditions we will be looking out for will be:
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Spinal tumours
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Spinal infection
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Tuberculosis
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Spondylolisthesis (forward slippage of the spine)
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Cauda Equina
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Fractures
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Spondylitis
An Osteopath being regulated under a parliamentary act will be skilled and responsible enough to recognise the signs and symptoms for a speedy referral to
1) your general practitioner
2) hospital/walk-in centre
3) private medical providers.
This is where an Osteopaths clinical medicine expertise really comes into effect. As is often said – it’s easy to be a technician, but a diagnostician & clinician is a very skilled and highly responsible job. Especially in the resource pressured NHS of today, it is good to have someone on your side that can act as another check and balance; helping you receive prompt and complete care.
Low back pain can refer to any number of structural problems. Muscles are among the easiest to resolve. Identify the muscle; massage, ultrasound, and needle it – hay presto! It’s a bit more involved than that – but in essence that’s what it is.
What Townosteo really specialises and excels in are problems with enthesiopathies & periosteal (bone) pains. Enthesiopathies are what I regard as “junction problems”. Where ligaments and tendons meet the surface of the bone. Below are 3 diagrams where all the ligaments of the low back are shown. It’s quite involved! We can’t help all the ligaments – because some are unreachable. But thankfully in the majority of cases the ligaments that are damaged are the ones we can affect either directly or indirectly.
Access free Back Pain & Sciatica resources
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Advice sheets
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Exercise sheets
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News letters
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Learn about injuries
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How to prevent injuries
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Rehab/prehab info
Investing in you
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Electrical spinal tractions
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Pulsed electromagnetic wave therapy
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Ultrasound
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Neuromuscular stimulation
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Electroacupuncture
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Acupuncture
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Joint & tissue manipulation
Nutrition
With an active interest in Functional Medicine - Yasin is qualified to give you nutritional advice to support your treatments
My favourite spinal ligaments to treat are the interspinous, supraspinous, intertransverse and facet joint capsule. By skilfully directly reaching these ligaments with needles, we aim to elicit structural changes to those ligaments. Structural changes that result in more tolerant nerves and stronger structures. We also aim to provide flexibility to some ligaments, because being overly stiff can result in a lessened ability to absorb and translate forces.
Sacroiliac Joint Pain
The below diagram is a view of your pelvis from behind. Let’s get our landmarks! Put your hands on your hips with your fingers forward and your thumbs traveling down and behind your back. Do you feel those back dimples? That is the ‘posterior superior iliac spine’. In the diagram it’s coloured red. To be more specific – it’s the top portion of bone coloured red; the other regions have other names! Important for us clinicians in forming our diagnosis and treatment plans. But technically the Sacroiliac joint is formed between two bones; the one coloured red and the triangular one with many holes.
Injury/damage to this area is usually referred to by a number of classifications:
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Sacroiliac joint syndrome
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Sacroiliac joint strain
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Sacroiliac joint sprain
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Mechanical low back pain
Yasin is a clinician who prides himself in being the best diagnostician he can be. He often thinks of ‘syndrome’ as a way of a clinician saying ‘I’m not quite sure’ or ‘around there somewhere’!
Ideally one needs to be able to identify if it’s a:
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Problem on the surface of the bone (periosteum)
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Sprain (ligament injury) as can be seen from the below diagram. One of the ligaments is shown, coloured in pink. There are other ligaments that affect the joint too, but let’s not get into that!
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Strain (tendon or muscle related to the joint), as seen in the below diagram, In this instance I’m showing the Gluteus medius muscle. Look how it comes near the Sacroiliac joint, In-fact it attaches to what is termed the lateral aspect of the PSIS! A great clinician will take time to figure out not only which joint is injured, but where in the joint that injury is. As in this case – if it’s the outer aspect – then one has to check the gluteus medius too. Because just treating the joint alone might not work in the long-term if the muscle keeps pulling on the joint.
A complete assessment and treatment approach can also incorporate movement analysis and reparative exercises. You might have a gluteal weakness leading to a sacroiliac joint sprain.
Not only do we have to investigate and treat the gluteal muscle, we also have to ask why the muscle is weak. We have an exercise studio where we can look at your movements, muscle strengths, flexibility, nerve flexibility, stability and patterns of muscle recruitment!
Sciatica
Everyone has a sciatic nerve! The Sciatic nerve originates from the lower portions of your spinal cord (Lumbar and sacral regions). Like a tree, your spinal cord is the big trunk and the main branches are the spinal nerves. The spinal nerves come out of the main spine, exiting the bones of the back. These branches travel down the back, through the buttock and then bundle together and become one very thick cord. The cord courses down the buttock, behind the knee and splits to feed different parts of the leg. It reaches as far down as the big toe
This adjacent picture shows just how complicated and wired we are! The thick yellow cord is the sciatic nerve. Can you follow it from where it starts and to where it goes? It’s very tricky!
Sciatica is when any part of this nerve gets irritated. Think of the nerve as a highway continuously sending signals down. If the highway gets damaged – traffic will slow down and can eventually come to a stop, and there will be lots of pain! Lots of pain! At TownOsteo we specialise in helping to “clear the highway!”
The main symptoms of sciatica we see in clinic are:
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Shooting, pins, and needles or numbness down the leg, especially below the knee. On the whole, if the pain does not travel below the knee – we don’t tend to consider it as sciatica. Click here to see our article on sacroiliac joint pain.
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A lot of discomfort when walking and sitting.
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Weakness in the leg and foot muscles.
The main signs of sciatica we look for in clinic:
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We (very gently) hit you with our mallet! We do this to check your reflexes. We check your individual muscle strengths and physically stress the nerves in different positions. We might even use very small and blunt needles to check the sensations on your skin. All this helps us to “read the nerve”. Giving us vital information on where the traffic jam is, what is causing it, and the extent of the damage.
Red Flags
We are well trained and experienced enough to ask the right questions and interpret the results to screen for anything serious. On occasion, we will ask your permission to write to your doctor, other times we will be happy to start treatment straight away.
We have an excellent network of private providers we can call on to assist us to help you. From companies that offer outstanding medical imaging services – to private practice doctors who will engage with you and our clinic in helping to provide answers and solutions.
Let’s talk about the different causes of sciatica.
