Acute Back Pain
The most common cause of back or neck pain, which has only been present for a short time in an otherwise healthy person, is usually some sort of sprain or strain. A number of tissues can be the source of the pain, such as the muscles, ligaments, discs, joints or a combination of these. Usually the pain will respond for better or worse to movement and is often referred to as simple mechanical back pain or simple acute back pain. The use of the word “simple” can often seem inappropriate to the sufferer for whom the pain may be very frightening and temporarily debilitating.
Mild strains of the ligaments or muscles are usually felt as a low-grade dull ache, either side or to one side of the spine. It may take from a few hours to a few days for the symptoms to reach their peak; the pain will tend to be aggravated when attempting to stretch away from the side of pain.
Pain originating from the discs may be felt as vaguely located central back pain that is aggravated by bending and twisting movements.
Sometimes simple mechanical back pain can be very intense and shocking, with muscles suddenly going spasm. This will usually be felt as a sudden spontaneous gripping or contraction of the muscles either side of the spine, possibly with a winding sensation as one tries to move. This is usually the body’s way or stopping further injury.
Alternatively there may little in the way of obvious muscle spasm, with the pain being felt as a sudden sharp stab of pain, which may restrict movement of the spine, or the stab of pain may be felt on bending backwards or towards the side of pain. This often indicates a problem in one of the small knuckle sized joints of the spine called “facet joints”. The joint could be “locked” or have shifted slightly out of place.
Physical therapy, such as osteopathy, chiropractic or physiotherapy, can often speed up recovery from simple mechanical back pain. However this is not always essential because, with the right sort of self care, most cases will start to improve after 1 to 2 weeks without the need for significant medical intervention and by 4 – 6 weeks most cases will usually be resolved. Even acute facet locks, as frightening as they are at the time, often resolve themselves after a week or two.
If you are suffering with acute mechanical back pain, general advice is to avoid bed rest of more than two days and keep mildly active. Anti-inflammatories and pain killers during the first couple of days are often a good idea in order to help you manage the symptoms and keep active.
If the symptoms do not start to improve after one or two weeks, or if the problem persists for more than 6 weeks, then you may need the help of a good physical therapist. Certainly if symptoms get worse after a couple of weeks, are accompanied by general signs of ill health or start to include significant pain, weakness, numbness or pins and needles in the arms, legs or any other part of the body, it would be wise to consult a health care professional such as your GP.
Chronic Back Pain
There can be several reasons for long standing back or neck pain. Occasionally it can be due to rheumatic conditions, however for the majority of chronic cases it will be due to ongoing mechanical back pain.
Mechanical back pain refers to the mechanics of the spine; the muscles, joints, ligaments and discs. It could have started with an injury, like a muscle strain, but for various reasons the injury fails to repair properly or causes secondary ongoing effects, such as altered posture or altered muscle function. This type of chronic problem can also involve a gradual accumulation of age related wear and tear.
Several factors can predispose or maintain chronic spinal problems, for example scoliosis, poor posture or muscles of the spine that have become weakened, knotted and fibrous.
There is often much that can be done to rehabilitate someone with chronic mechanical back pain and even someone with long standing degenerative wear and tear problems. The important thing to remember is that with problems that are long standing in nature, a number of factors will contribute to the overall picture. This is likely to involve the development of bad postural habits and abnormalities in several tissues of the spine, including the ligaments, muscles, joints and discs, and even problems in parts of the spine away from where the pain is. All these factors need to be addressed for maximum improvement.
Surgery is rarely required. The best initial type of help is likely to come from a good physical therapist who will be able to assess the individual parts of the spine, provide exercise advice as well as deliver manipulation and electrotherapy techniques to address the individual tissues of the spine that are at fault. It is important to remember that there will often be no quick fix and it may take many sessions for chronic problems to improve. There will also usually be considerable work for the patient to do for themselves, with stretching and strengthening exercises under the guidance of their therapist. Problems involving significant wear and tear can require regular top-up sessions to maintain progress. As a rough guide, improvement in symptoms should start to occur within about 5 sessions but the overall number of sessions will vary greatly depending on each individual case.
Cases that do not respond to physical therapy may need to consider long standing pain killing, anti-inflammatory medication or spinal injections under the care of an orthopaedic or pain clinic. The aim of these procedures is to provide pain relief, not repair the damaged joint, and is usually only temporary, possibly lasting up to several months. As a last resort spinal surgery can be considered to remove the affected facet joint but this is not without potential complications and side effects.