Common Back Injuries

Discogenic pain arises when the outer fibres of the lumbar disc are injured. These injuries typically occur when the low back is placed in flexion and/or rotation. Often the core of the disc may bulge through the outer fibres of the disc. The pain from dicogenic pain is deep and constant and is often worse in the morning. The pain tends to ease as the day goes on or with gentle activity. These injuries often present with compounding issues such as poor control of the muscles around the lumbar region. Treatment for discogenic pain is orientated towards decreasing the pain, improving the control of the deep muscles of the spine and improving awareness of spinal position.  If the bulge in the disc is significant these issues can produces significant inflammation or compression of a nerve root in the region. Discogenic pain may progress to radiculopathy or radiating leg pain (sciatica) in these situations.

Sciatica (Radiculopathy) differs from other forms of referred pain in that the conduction of the nerve is reduced. In its less severe form a small reduction in strength, sensation or reflexes may be seen in the area of the body supplied by the affected nerve. Radiculopathy normally arises when there is compression of the nerve from a spinal structure such as a disc. This is often referred to as a "trapped nerve." Treatment involves decreasing the pain, improving deep muscle control, improving awareness of lumbar position and addressing the symptoms in the nerve tissue. It is important to differentiate radiculopathy from neuropathic pain because in neuropathic pain there is no conduction loss and the pain is normally present due to tension or irritation of the nerve. In this situation the nerve needs to be treated with special manual techniques that sooth the irritated/ tensioned nerve.

Sciatica (Neuropathic) pain refers to nerve pain. In back pain patients this pain may be felt down the leg but presents without conduction loss (loss of sensation, reflexes, muscle strength). Recent research has shown that neuropathic pain can arise when there is tension or irritation around the nerve normally at its interface with the spine. The easiest way to think about neuropathic pain is to imagine that the nerve itself is inflamed. Nerves themselves are supplied by the nervi nervorum which essential means the "nerve of the nerve" these nerves can be become hypersensitive resulting in ectopic firing or transmission of pain without a specific stimulus this means that pain can be felt down the leg without any loss of muscle strength, sensation or reflexes. This situation can often be readily resolved using specific manual therapy techniques which sooth the irritated and inflamed nerve tissue.

Facet Joint irritation occurs when the joint is injured through compression, rotation, extension or a combination of these movements. Facet joint injuries often occur when the spine is placed into extension for example when reaching up to hang a picture or to change a light bulb. These injuries can be treated effectively with mobilisation or manipulation which provides a reduction in pain and improvement in range almost immediately. For the best long term outcomes a specific therapeutic exercise programme needs to be implemented. This programme of exercise helps restore normal muscle control in the region and an emphasis should also be placed on spinal posture and awareness.

Sacroiliac Joint pain is a common cause of low back pain. Sacroiliac joint pain often arises after a fall onto the buttock or during and after pregnancy. The Sacroiliac joint is the joint between the Sacrum (triangular shaped bone of the pelvis) and the pelvis. The shape and resting position of these bones is designed to produce stability but occasionally through trauma or postural and hormonal changes they become irritated. This situation produces changes in the distribution of force through the joint which can cause further pain and inflammation. This is commonly experienced as an inability to weight bear on the affected side and pain performing activities of daily living. Treatment of sacroiliac joint pain involves assessment and treatment of the joint and the muscles that surround the joint and helping to restore normal force distribution through the joint sometimes with the use of aids.

Spondylolisthesis refers to a slipping forward of one vertebra on top of another. This injury is often associated with a bilateral pars defect and usually occurs in those with a family history of the condition. It is most common in children between the ages of 9 and 14 years of age and usually occurs between the L5 and the S1 vertebra. Spondylolisthesis is graded according to the degree of slip with a grade I representing a 25% slip. Beyond grade I spondylolisthesis normally require surgical intervention.

Osteoarthritis refers to the degeneration of the joint that occurs with use. Most people over the age of thirty will show some degree of "wear and tear" in their joints from the stresses of everyday life. Osteoarthritis cannot be repaired but further damage can be minimised by improving the muscles that surround the joint. In the lumbar spine this refers to the "core musculature" and specifically refers to the force, timing and sequencing of muscle activation rather than the strength of the muscles in this region. The pain from osteoarthritis can also be improved through various manual techniques such as myofascial release and mobilisation.

Stress Fractures of the pars interarticularis generally tend to arise in young athletes in sports that require repetitive hyperextension and rotation. Sports that this injury is commonly seen include, tennis, cricket, dance, weightlifting, and other throwing sports. There is normally pain on one side of the back and it is often reported as occurring after one specific movement. The management of these injuries includes activity limitation and specific core control activities that improve the muscle control in the region.