Back pain is very common. Whilst sometimes very painful, back pain fortunately is rarely caused by serious pathology.
There are a great many myths regarding back pain and this, along with the wide variety of treatments used to manage it can quite understandably lead to confusion.
Perhaps the most critical thing to understand about low back pain is that there are both many different causes and types. Thus, a “one size fits all” treatment approach is not appropriate; rather, a tailored program that takes into account both the type of disorder that presents and why it has occurred is more likely to be met with success. For example, a fast bowler who has a stress fracture in their lower back will need any technique error addressed, whereas somebody who presents with an inflammation disorder will not do well unless they are medicated appropriately along with an exercise program.
The first step in managing lower back pain is to have it correctly diagnosed. A thorough history and physical examination is the key here. Investigations such as x-rays are generally not helpful, but in some instances are required. Treatment can then be targeted toward the individual’s presenting problem and should always involve addressing the cause(s) of the disorder and putting strategies in place to help prevent recurrence.
There are many myths regarding pelvic pain. The reality is that it is (along with lower back pain) quite common during pregnancy, with the majority of women experiencing it in some form; but it is often just a minor inconvenience and self limiting after the birth of baby. In other instances however, pelvic pain can be more severe, disabling or persistent, in which case assessment is recommended. Pelvic pain is also frequently seen in the sporting population.
There are a number of potential sources of pelvic pain, including inflammatory disorders, bone stress, referred pain from the lower back, tendon and muscular problems. Successful treatment requires the identification and management of all factors that are driving the problem so that long term and not just short term relief from treating symptoms alone is achieved.
Neck disorders are prevalent and affect approximately 70% of individuals at some point in their lives. The very great majority of these problems are benign in nature, but particularly if they are not well managed, they may become a persistent and recurrent disorder. Neck problems can also give rise to headaches, upper back and arm pain and on occasions, dizziness.
There are a number of different causes of neck pain and it should not just be considered as one disorder. Different presentations respond to different types of treatment and so this should always be individualised according to how the patient presents. An unsuccessful response to treatment often just means that different therapy is required. There is strong evidence to support physiotherapy intervention for neck pain, particularly when manual (“hands on”) therapy is combined with appropriate exercise prescription.
As with all musculoskeletal complaints, with neck pain it is important to target treatment to the individual’s particular presentation to obtain the best results and it is vital to identify and address the cause of the problem, as well as put strategies in place to help prevent recurrence.
Sciatica refers to leg pain that has its origin in the lower back as the result of nerve irritation or compression. It is important to note that not all leg pain referred from the lower back is sciatic pain; there are many other causes of these symptoms and treatment should be directed accordingly.
The evidence is strong that the long term results for sciatica are identical for conservative and surgical treatment, although surgery has a significant role to play in some cases. Physiotherapists are trained to identify whether leg pain is indeed sciatic in origin and in the majority of cases this can be settled with conservative measures. Early identification of the much smaller number of presentations requiring specialist management can also be made, thus ensuring optimal care is provided.