Back, neck and joint pain

Back pain is by far the most common reason that people come for physiotherapy and is often misunderstood. 

 

Back pain accounts for 40% of working days that are missed and around one-third of the UK population will experience it every year. 


Lower back pain, or what we call pain in the lumbar spine, is the most common. 
The majority of back pain is not caused by anything serious and it is important to remember that it is not a ‘disease’. 


Back pain will usually go away on its own or with the right management within six weeks. 

It’s important to understand back pain to improve recovery and prevent future reoccurrence. 

The back isn’t a single bone, muscle or structure.

You have 24 separate bones called vertebrae that make up your spine. Around each of these you have a small disc that acts as a shock absorber when you twist or bend the vertebrae. 

The disc is made up of cartilage and contains fluid to help with movement. As you get older, the fluid in the disc tends to reduce which makes your back less flexible. 
Right at the bottom of your spine (the area you sit on) you have your sacrum and coccyx, which are smaller bones that tuck inwards slightly. 

You have a long cord that runs through your spine and transports nerve signals between your whole body and your brain. 

Around your spine you then have a range of connective muscles, ligaments, tendons, tissues and nerves. 


When you put all of these components together you have a sophisticated and complex structure. 

Your back is strong and perfectly designed to keep you upright and to support the millions of small tasks and movements that you complete every day. 

Most of the components in your back are pain sensitive, which is why you experience back pain if they are under abnormal stress or overloaded.

What is classed as back pain?

Back pain can affect different people in different ways. 

It is usually either pain or stiffness, but can also be a combination of both.

It may be a sharp pain that starts suddenly or a small discomfort that gradually increases over time. 

The pain may feel focused to a particular area for some, but for others it may feel like it moves around and transfers to other areas. 

The below are common symptoms of back pain:

 

• Sharp pain 
• Dull aching pain 
• Pain that travels to your buttocks, hips or legs 
• Stiffness or difficulty moving without pain
• Discomfort when sitting or staying in the same position for long periods 
• Pain that feels better when you change positions 
• Difficulty sleeping and pain when you wake-up 

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Are there different types of back pain?
There are many different types of back pain and clinical diagnosis, but for the purposes of this article let’s look at the two main areas that we see. 

The first is what we call ‘back dominant pain’. This is typically felt around the spine and possibly radiating into the buttocks. 

People with back dominant pain can experience spasms and usually find that certain positions or movements aggravate the pain. 

The second type of back pain that we commonly see is ‘leg dominant pain’. This is where the pain is felt more down the legs than in the back.  


One form of leg dominant pain is sciatica. Sciatica tends to be felt down the back of the leg and often in the hamstrings.

Another presentation of leg dominant pain is when patients only feel the pain when walking or standing and often describe a heaviness that gets worse in the legs.