PhysioMonkey

So another huge topic to be done succinctly.

Firstly the vast majority of back pain is not worrying medically.  Of course it may concern you but it doesn't mean there is a horrible problem underlying it.  For clarity we're talking about lower back pain here.

Let's talk about the common things that people have heard about:

1 - Lumbago

Definition: Lumbago: painful condition of the lower back.  In other words "back pain".

This is NOT a diagnosis.  It is a way of telling you that you have back pain.  You would probably already know that though.

2 - Sciatica

Definition:Sciatica: Pain along the sciatic nerve usually caused by a herniated disk of the lumbar region of the spine and radiating to the buttocks and to the back of the thigh. [from dictionary.com, def 1]

Firstly this definition is WRONG [Edit: actually there is some debate about this.  Technically you could argue that you need true nerve iritation to be "proper" sciatica which would mean that the above definition is correct.  However the term is generally used to mean "pain down the back of leg" by pretty much everyone except pedants].  Pain down the leg may be down to a disc problem but rarely is.  More commonly it's down to a problem with joints in the spine or possibly a muscular issue in the buttock.

3 -  Slipped Disc

Definition: Slipped disc: a painful rupture of the fibrocartilage of the disc between spinal vertebrae; occurs most often in the lumbar region [from dictionary.com]

So some anatomy.  If you want more there are loads of anatomy sites out there on t'interweb.

There are 24 seperate bones in the spine, the top 7 make up your neck, the next 12 have ribs coming off them, this is the "thoracic spine" and the last 5 bones are called the lumbar spine.  At the top is your skull, at the bottom is a bone called the sacrum which is like 5 of the spine bones all fused together, under the sacrum is the coccyx or tail bone, this is tiny but can cause real pain (if you've ever fallen and landed hard on it you'll know about it).

Inbetween the bones are what are known as the discs.  Think of them as a jam donut.  The outside is fibrous and strong and the inside is gooey.  They act as shock absorbers for the spine.

The name "slipped disc" is rather a misnomer giving the impression of the whole disc shifting somehow.  The definition above is correct for a change, the "jam" pushes backwards (in most cases).  In minor cases the back of the "donut" bulges backwards and pushes on nerves.  In extreme cases the disc ruptures causing massive pressure and chemical irritation of the nerves. This is a slipped disc.  The other notable thing about slipped discs is that they tend to come on in an instant (but not always).  Often this is during a normal activity that may even be much less strenuous than you'd expect problem movements to be.  Eg you work as a builder and lift heavy weights all day, one evening you bend down to pick up a pen and your back "goes"; that's the classic slipped disc pattern.

One of the benefits of getting old is that the "jam" dries up so leaving you less likely to have a slipped disc.  Most slipped discs happen in people aged 30-50.

4 - Mechanical back pain

The most common form of back pain by far.  The non-specific title tells you a lot about the mechanisms here.

Quote: "In the majority of cases, it is impossible to identify the exact cause of backache" [netdoctor.co.uk]

I'd agree with this.  People then assume that nothing can be done with it.  This is rubbish, almost all physical back pain can be treated.  It's a combination of muscular problems, joint problems, postural deficit and sometimes hormonal changes and anxiety/stress.

5 - Chronic back pain

Definition: chronic: Of long duration. Used of a disease of slow progress and long continuance. [dictionary.com]

This is distinct from recent onset back pain (aka acute back pain).  Chronic pain is a whole different area of medicine.  It involves physiological changes in the brain, perhaps some emotional difficulties either directly because of or not helping the pain, changes to the perception of self and your pain and numerous other things.  This is much harder to deal with if there is no specific pathology (as with most back pain).  Imagine being told that there's actually nothing much wrong physically if you've crippling pain.  The only demonstrable help there has been for this problem is a combined approach involving physio, doctors, psychologists and other medical profs eg occupational therapy.  You'll be damned lucky to find a service that'll help you out with this.

Please note that simply having back pain for a long while means that the pain is chronic (in time terms) but doesn't necessarily mean you go through all the physiological changes that result in nasty "chronic pain" meaning what's in the paragraph above.

Things you need to know.

Normal episodes of back pain.

• The vast majority of back pain is not medically concerning.
• Most episodes will last less than 6 weeks.
• Most back pain is called "simple, mechanical back pain".
• Treat it yourself (check the "treatment" posts).
• You need to get the muscles working.
• The worst thing to do is "nothing".
• You're not likely to injure your back further with normal unloaded activity.

Concerning things

• Nasty, unrelenting, unchanging pain.
• Sudden, significant and unplanned weight loss.
• Pain doesn't change at all (most will vary depending on position, posture or activity).
• Real difficulty sleeping because of the pain.
• Numbness around the inner thighs and groin.
• Inability to control bladder or bowel normally.
• Recent onset major muscle weakness in the legs.
• Pain started after major trauma.

These are what we call "Red Flags" they can indicate some pretty nasty things that need urgent checking.  If you have more than 1 of these then get yourself checked quick.

We also have "Yellow Flags" these are described as "factors increasing the risk of developing long term problems or disability".  These are:

• Belief that back pain is harmful or severely disabling.
• A legal or compensation claim in progress.
• Fear of movement or activity.
• Anxiety/depression.
• Expectation that someone will heal them rather than to play an active role in their own health.

So if you see these in someone without any serious pathology then give them a kick up the backside from me.

Related Posts

Back Pain - Myths and Truths

Back Pain - Treatment 1 - What others can do for you

Back Pain - Treatment 2 - What you can do