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

RSI is a very mis-understood term.

Definition: R.S.I. : Damage to tendons, nerves, and other soft tissues that is caused by the repeated performance of a limited number of physical movements and is characterized by numbness, pain, and a wasting and weakening of muscles. (Taken from dictionary.com, definition 1 on RSI)

R.S.I. is not a diagnosis; it is a syndrome.

Definition:  Syndrome: A group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition. (Taken from dictionary.com)

 

In other words if someone says you have RSI he or she is NOT giving you a diagnosis.  He's merely telling you that your symptoms fit into the pattern.  It's rather like going to the doctor complaining of a headache and being told "You have a headache".  It doesn't get you much further in knowing what's happening to you.

To begin with it is not just about tendons (as the definition shows).  Tendons are affected but so are most of the structures around.  Nerves get damaged as they are overused, blood vessels can't deal with the amount required and the whole lot fails, slowly. 

Recovery is slow and based around rest.  Remember that the neck may be involved; often people respond best to neural mobilisations and neck physio. People often find that splints for the wrists are helpful.  There is no magic bullet though so if you end up with RSI then get yourself ready for a long haul.

The best advice is not to get it; so vary your workouts, don't stick to one skill the whole time even if you're a pro wanting to work on one aspect only.  Professional athletes do not spend their whole time on one aspect of their sport, vary your training regime to give you a good variety of stresses and practice.

Related Posts

What is - Tendinopathy

Repetitive Injury and Pain

Definition: Any problems with tendons.

Definition: Tendon : inelastic cord that attaches muscle to bone.

There are a number of different problems that all tend to get lumped in as "tendinitis".

These include:

1. RSI.
2. Tendinitis.
3. Tendinosis.
4. Tenosynovitis (tenovaginitis in the US).

1 - RSI

Look under the post "Condition - RSI" under the category "What is?".  RSI tends to be lumped in with tendinopathies but isn't quite.

2 - Tendinitis

Definition: tendinitis : inflammation of a tendon

This is nearly worthy of puttng under the category of "Controversy" but not quite. 

Historically any tendon trouble less than about 2-3 weeks old was diagnosed as tendinitis.  In fact it seems likely that tendons rarely inflame; they're not vascular (not many blood vessels) enough to do so. 

The usual treatment has been steroid injections.  These are now not recommended.  The major action of steroids is as an anti-inflammatory; tendinitis rarely exists hence little inflammation to treat.  In fact the physical damage of putting a needle into a damaged tendon often makes the tendon weaker and more likely to rupture.  If you are advised to have an injection into a "tendinitis" make sure you have talked about this!

3 - Tendinosis

Definition: tendinosis : chronic deterioration of the tendon

Much more common than tendinitis.  Tendinosis happens as a gradual accumulation of tiny amounts of damage to the tendon.  Over time this damage adds up to enough to cause pain and disability.  Historically any tendon pain over about 1 month was called tendinosis.  Treatment is rest and slow building up of nomal stresses through the tissues (ie gentle exercises and stretches).  This can take months; some people never respond well.  Anti-inflammatories and injections are not helpful.  Sometimes surgery is recommended; this depends on the individual circumstances and is not a panacea.

4 - Tenosynovitis (Tenovaginitis)

Definition: tenosynovitis : inflammation of a tendon sheath

Some tendons (notably for us in the wrist) have sheaths that they move inside of.  This can be inflamed via similar over-use problems and can be as painful and debilitating as the others.  You may have heard of "de Quervain's" disease; this is an example of tenosynovitis in the wrist. 

Injections can be useful as a treatment for this.  Otherwise the same treatment regimes as for tendinosis will work.

Further Information

Further and more technical detail can be found here.

Related Posts

What is - R.S.I.

Repetitive Injury and Pain