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Pain in the Back! - Diagnosis and Treatment

Back pain is a common problem that can affect people of all ages and can have a significant impact on daily life. It can be caused by a variety of factors such as poor posture, muscle strain, injuries, and degenerative disc disease. There are many non-invasive treatment options available to help manage back pain. In this article, we will explore in detail the causes of back pain, how to diagnose the causes, what a doctor does when a patient attends an appointment with back pain, what imaging modalities are available in managing back pain, the treatments available with focus on physiotherapy, medications, injections, orthotics, and other non-surgical options.

Causes of Back Pain

There are many causes of back pain, ranging from poor posture to spinal injuries. The most common causes of back pain include:

Muscle strain - This is one of the most common causes of back pain. It can be caused by overuse, poor posture, or sudden movements.

Bulging or herniated discs - The spinal discs act as cushions between the vertebrae to allow the spine to move. If a disc bulges or herniates, it can put pressure on the nerves in the spine, causing back pain in addition to pain down the legs as in Sciatica.

Spinal stenosis - This is a narrowing of the spinal canal that can put pressure on the nerves in the spine.

Facet arthritis - This is a degenerative joint disease that can affect the joints between the spinal vertebrae and can also cause stiffness in addition to back pain.

Scoliosis - This is a twist and curve of the spine that can affect people of any age, but most often starts in children aged 10 to 15. Usually noticed when one shoulder is higher than the other.

Osteoporosis - This is a condition that causes the bones to become weak and brittle. It can lead to fractures in the spine, which can cause back pain. In some cases, it could lead to Kyphosis (increased forward curvature of the spine).

Diagnosing the Causes of Back Pain

The first step in managing back pain is to identify the underlying cause of the pain. This is done through a comprehensive evaluation by a medical professional, which may include a physical examination, medical history, and imaging studies.

When a patient attends an appointment with back pain, the doctor will ask detailed questions about the patient's symptoms and medical history. They will perform a physical exam to assess the patient's range of motion, muscle strength, reflexes and special clinical tests. Imaging studies such as X-rays, CT scans, and MRI scans may also be ordered to provide more detailed information about the cause of the pain.

X-rays are often ordered to evaluate back pain. They can help identify fractures, bone spurs, and other abnormalities in the spine. CT scans provide more detailed images than X-rays and can help identify more subtle fractures in addition to conditions like spinal stenosis, Scoliosis and Kyphosis.

MRI scans are considered the gold standard to evaluate back pain because they can provide detailed images of the spine and surrounding tissues. This type of imaging is non-invasive and does not involve radiation, making it a safe option for many patients. MRI scans are particularly useful for evaluating conditions such as herniated discs, spinal stenosis, and tumors. They can also be used to evaluate the effectiveness of treatments such as physical therapy or injections.

Read this article by ACTIVATE's Clinic Director Dr Alnaib for more details on imaging in back pain.

Treatments for Back Pain

Once the cause of the pain has been identified, a treatment plan can be developed. The treatment plan will depend on the underlying cause of the pain, stage of the condition, treatments already received and symptoms as well as the patient's individual needs and preferences. Some of the most common non-invasive treatments for back pain include:

Physiotherapy - Physiotherapy can help improve mobility, strength, and flexibility in the back muscles. This can help reduce pain and prevent further injury. Physiotherapy can be administered directly by a physiotherapist individually or in a class session or in the form of digital personalised physiotherapy prescription (DPPP).

Medications - Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, muscle relaxants and nerve pain medications. Some medications can be obtained over the counter while others might require a prescription.

Injections - Injections such as epidural steroid injections or nerve blocks can help reduce pain and inflammation in the spine for a considerable period of time.

Orthotics - Orthotics such as braces or shoe inserts can help support the spine and reduce pain when the cause of pain is related to abnormal or poor posture.

Chiropractic care - Chiropractic care involves spinal manipulation and other techniques to improve spinal alignment and reduce pain.

Acupuncture - Acupuncture involves the insertion of thin needles into specific points on the body to help reduce pain. It involves stimulating sensory nerves under the skin and in the muscles to produce pain releiving Endorphins.

Massage therapy - Massage therapy can help improve circulation, reduce muscle tension, and relieve pain.

Surgery for Back Pain

Surgery may be necessary in some cases of back pain, particularly if non-invasive treatments have been ineffective. Common surgical procedures for back pain include:

Spinal fusion - Spinal fusion involves fusing two or more vertebrae together to stabilize the spine and reduce pain.

Discectomy - Discectomy involves removing all or part of a herniated disc to relieve pressure on the nerves in the spine. Some of these operations can be performed using a minimally invasive technique through a key-hole incision.

Laminectomy - Laminectomy involves removing a portion of the vertebral bone to relieve pressure on the nerves in the spine.

Artificial disc replacement - Artificial disc replacement involves replacing a damaged spinal disc with an artificial disc to restore normal spinal function and reduce pain.

In conclusion, back pain is a common problem that can be caused by a variety of factors. Non-invasive treatments such as physiotherapy, medications, injections, orthotics, and other non-surgical options are available to help manage back pain. Imaging modalities such as MRI scans can provide detailed information about the underlying cause of the pain, while surgical options are available for cases where non-invasive treatments have been ineffective. If you are experiencing back pain, contact ACTIVATE or book an appointment online to identify the underlying cause of the pain and develop an appropriate treatment plan.

About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.


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