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Back Pain: Cause and Treatment

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About 800 New Zealanders visit their doctor each day with back or neck strain complaints, according to ACC. This is not including real back injuries or accidents, but only depicts the people who have a sore back or neck from overstretching. Worldwide, almost 80% of the population will suffer from a severe bout of back pain at least once in their life, whether it's from an injury, or just "putting your back out" while doing normal activities. The New Zealand "back problem" is reflected in direct costs to ACC of about $280 million each year.

Mechanical Back Pain
Most low back pain is caused by prolonged overstretching of ligaments and other surrounding soft tissues. The most common cause of overstretching is having poor postural habits in standing, sitting or lying. Mechanical pain may also be caused by severe overstretching which actually damages some tissues, which easily happens when playing sports or when involved in a minor accident. These types of injury cannot easily be avoided as they occur unexpectedly and without warning signs. When soft tissues surrounding a joint are overstretched, the ligaments usually give the first rise to pain. The ligaments in the spine are also shock absorbers between the vertebrae, so overstretching will (under certain circumstances) affect the disks.

Sometimes, when the ligament is injured to such an extent, the disc will bulge outwards, or in extreme cases, burst through the outer ligament, which causes severe pain. Should the soft tissue inside of the disc bulge excessively, the disc may become severely distorted and movements will be blocked partially or completely. This is the reason why some people with severe back pain are forced to stand with the trunk off-centred or bent forward, or why people with a sudden onset of pain are unable to straighten up or move the back properly.

Once soft tissues are damaged, pain will be felt until healing is complete and function is fully restored. It is important that during the healing process you avoid movements that pull the healing surfaces apart. When tissues heal they form scar tissue, which is less elastic than normal and tends to shorten over time. If shortening occurs, movement may stretch the scars and produce pain, which may cause a continuous source of back pain and/or stiffness. Appropriate exercises can be performed to restore normal flexibility, and help prevent and treat back pain in future events.

Where the Pain Can be Felt
Pain can be felt in the centre of the back, or near the belt-line. In subsequent attacks, the pain can be felt going down the buttocks, thighs or below the knee and down to the foot. If the problem is severe, you may also experience numbness or muscular weakness in the lower leg.

Treatment
Low back pain can be treated in various ways, and every case responds to a different type of treatment. If you would like professional advice, you could see your doctor, physiotherapist, chiropractor, osteopath, or even a naturopath or homeopath. Acupuncture has been known to help some cases of low back pain as well. Research has shown though, that about 80% of people suffering from low back pain can benefit from self-treatment. Robin McKenzie created a self-treatment programme as described in his book Treat Your Own Back. It has been developed to correct any distortion or bulging that may have developed in the discs of the low back. By reducing this distortion, the level of pain can be reduced.

Who Can Perform Self Treatment?
If you can answer yes to all these questions, you are an ideal candidate to treat your own back with exercises:
  • Are there periods in the day when you have no pain? Even 10 minutes?
  • Is the pain confined to areas above the knee?
  • Are you generally worse when sitting for prolonged periods or on rising from the sitting position?
  • Are you generally worse during or right after prolonged bending or stooping, as in making the beds, vacuuming, gardening, concreting, etc.?
  • Are you generally worse when inactive and better when on the move?
  • Are you generally better when walking?
  • Are you generally better when lying face down? When testing this you may feel worse for the first few minutes after which time the pain subsides: in this case the answer to the question is yes.
  • Have you had several episodes of low back pain over the past months or years?
If you have answered yes to more than four questions, your chances to benefit from self-treatment are good. If you have answered yes to 3 or less questions, you may require specialised treatment and you should contact a health provider (doctor, physiotherapist, chiropractor) or a therapist trained in the McKenzie Method http://www.mckenziemdt.org. In any of the following situations you should not commence an exercise programme without first contacting your health professional:
  • If you have severe pain in the leg below the knee and experience sensations of weakness, numbness or pins and needles in foot and toes.
  • If you have developed low back problems following a recent severe accident.
  • If, following a recent severe episode of low back pain, you have developed bladder problems.
  • If you are feeling generally unwell in conjunction with this attack of low back pain.
Copyright Spinal Publications New Zealand Ltd 2002.


By Robin McKenzie CNZM,OBE,FCSP,FNZSP(Hon),DIP MT
All rights reserved. Any reproducing of this article must have the author name and all the links intact.

Author: CNZM,OBE,FCSP,FNZSP(Hon),DIP MT

Biography: Robin McKenzie is a world renowned spinal expert and is recognized internationally as an authority on the diagnosis and treatment of lower back pain and neck pain. He founded Spinal Publications in 1980, to publish his works. His titles have been translated into many languages, and have sold millions of copies all over the world. He is also the founder of the McKenzie Institute, a non-profit organization with headquarters in New Zealand and 26 branches throughout the world.

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Back Pain: Cause and Treatment


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