Proven approach to the treatment and prevention of back pain and sciatica

Many things can cause low back pain in women. It may be biomechanical, mental or physiological. This means it may come from the structures of the back and pelvis itself due to laxity or dysfunction, or to do with an inflammatory/physiological process (menstruation, diet issues, autoimmune etc), or even mental health issues.

Yes. The nerves detecting pain from your bowel also detect pain from your back. Your brain makes the decision that the back is more likely to hurt and causes back pain. To know if this is what is causing your back pain, keep an eye on your bowel habits and how much your back hurts. If it occurs at the same time, it may be the cause.

Back pain is caused by three main things: biomechanics, mental health and physiology. But biomechanical back pain can be due to significant trauma or repetitive minor traumas which don’t cause a problem until it reaches a threshold where it causes injury (disc herniation, facet sprain etc).

This depends on the cause of your back pain. If there is muscle tightness then heat may help. If there is inflammation then ice may help. But the most important thing to do for most problems is to keep the area mobile in some sort of way. Whether it is loading the muscle, stretching the muscle or just simple range of motion exercises. Ask an expert if you are unsure.

If you are experiencing pain you should always seek help for it. The majority of the time it is mechanical and can be resolved with some combination of treatment, exercise and lifestyle changes. There is no sense in putting up with it. In some rare cases upper back pain can have a more sinister cause, clinicians are trained to recognise the symptoms. If you aren’t responding to treatment as expected by your first review visit we often refer for further investigation to rule out worrying causes, though this is rarely needed in practice as it is uncommon to have sinister back pain.

It can be but this is rare. If you have a history of cancer, this is something we consider when diagnosing you. If you are unwell, experiencing weight loss, extreme fatigue, severe pain through the night that isn’t relieved by any rest, movement or stretching then it is worth seeing a doctor for further investigations. Upper back pain is far more commonly a symptom of our modern lifestyles and completely mechanical in nature.

Most causes of back pain are similar in both male and female and have more to do with your lifestyle and daily activities than your gender. The exceptions to this can be referred pain in your back from your menstrual cycle or gynecological issues. The nerves that supply your uterus and ovaries come from the lower back, in some people you can “get your wires crossed” and feel the pain in your back. One of the other gender differences we get is the role of estrogen in bone density, post menopause (or hysterectomy) women can be more prone to osteoporosis, which can give back issues (crush fractures) further down the line. The other female factor in back pain is pregnancy. The position of your body and the impact of relaxing hormone can lead to back and pelvic pain, this usually resolves post pregnancy.

The nerves that innervate your uterus come from your lower back. In some cases, the pain that is starting in the uterus can refer to the back. Sometimes this is purely due to your period and its severity, but in some cases it can be caused by endometriosis, it is important to get a diagnosis so you and your medical team can know how best to treat and support you.

Acupuncture can be a fantastic pain relief option in many cases of back pain. The best way to resolve back pain is to identify the reason it started and treat the cause. Muscle tension can be the cause of some cases of back pain, and acupuncture can be the solution, but often, more indepth treatment is required, including exercises and stretches that correct the cause of the muscle tension and not just the symptom. We don’t often use acupuncture as a stand alone treatment, but integrate it into our treatment plans.

Sciatica is known as pain that refers down the leg in the path of the sciatic nerve. This path is from the buttocks, down the back of the leg and to the foot. Usually, the pain is sharp shooting and can come with pins and needles and/or numbness. The reason behind this is due to irritation or compression of the nerve from a structure in your lower back or pelvis, whether it is a spinal, pelvic or muscular cause depends on the reason behind the issue. 

The only way to cure sciatica permanently is to find the cause and remove it. For example, if the reason is that a muscle is compressing the sciatic nerve in the buttock then reducing the tension on that muscle will get rid of the symptoms of sciatica. But, the cause of that muscle tension must be addressed, otherwise it will come back. That may be numerous causes such as work postures, an orthotic need or an underlying issue that is truly causing the muscle to compensate in the first place. The best thing to do is ask a professional. 

This depends on the cause of your sciatica. If it is caused by a disc herniation, then most likely this has been building up for a while. Discs can take a lot of pressure when healthy, that is their job. But after years of minor traumas their injury threshold gets smaller until a small movement that you have done many times before causes the disc to herniate. It is like bending a credit card forward and backwards, after a while the credit card will break even with the littlest force. Slouching in a chair and lifting a box are both examples of microtraumas if done for prologues periods of time and done incorrectly. 

Most of the time, sciatica is caused by something relatively minor. However, you should always look out for the following as it could mean it is serious: 

• Have sciatica down both legs 
• Have weakness or numbness in both legs that is severe or getting worse 
• Have numbness around your private parts 
• Difficulty when urinating or controlling urine, and abnormal for you. 
• Difficulty pooing or controlling your bowels, and abnormal for you. 

Most often back pain is short lived and caused by simple ‘mechanical’ issues. If you’ve been sitting a lot in a slouched posture or overdoing it in the garden, you might find that your back gets sore. In the absence of obvious, traumatic injury (like a car accident) back pain which continues or worsens usually has a combination of underlying causes which could include more established mechanical issues (the way your body holds and moves itself), underlying health conditions, and lifestyle factors – like the quality of our sleep, or stress levels. Very rarely, back pain can be associated with a serious condition such as cancer. It’s also very rare that back pain signals a medical emergency, unless it’s come on very suddenly following a traumatic event, or is accompanied by other symptoms like loss of feeling in the limbs, incontinence, or other extreme symptoms.

If back pain is bothering you it’s never a bad idea to get some reassurance and advice. If there’s an obvious reason for your new back pain (for example, a fall) unless the pain is severe or accompanied by other symptoms like loss of sensation in the limbs, it’s very unlikely to be a medical emergency. If your back pain isn’t improved by self-care strategies like anti-inflammatory painkillers, warmth, gentle stretches and movement, it’s a good idea to seek professional advice.

It’s very unlikely that anything is seriously wrong, but the longer your pain continues, the more you’re likely to change your habits to accommodate it, which can in turn make the pain more long-lasting. In the majority of cases back pain isn’t caused by anything sinister and nor is it a medical emergency, but if you’re in any doubt or your worry is affecting your day to day life, do seek professional advice.

Every month dozens of patients come to us with back pain. Many have been suffering for years or even decades. They’ve seen doctors, therapists, consultants, surgeons.

They’ve had Xrays, MRIs, therapy, surgery. All this, and not once has anyone explained to them why they have back pain, far less how it can be treated. How is this possible?

Because the people they’ve seen before don’t see enough patients with back pain that’s specifically like your back pain and they are only seeing one part of the puzzle – the part they are trained to see.

Because we are so specialised and expert in helping patients with back pain we have unprecedented expertise in identifying the specific combination of factors that have led to YOUR back pain and that are preventing you from recovering.
Because we are such an integrated multi-disciplinary team of experts, working in partnership with our patients, we can see and pull together all the bits of the jigsaw to help you achieve the fullest possible recovery.

That’s why before we even consider offering you treatment we will take you through an incredibly thorough consultation, examination and assessment, in order to identify exactly why you are experiencing the symptoms you are.

Only once we have a clear and detailed diagnosis, which makes absolute sense to you, will we offer you a treatment and self-care plan.

The reason back pain can be difficult to treat is, primarily, that many people who claim to treat back pain don’t know how to properly diagnose it (as we explained above)

If you can’t explain in detail the causal mechanisms for a particular individual’s back pain then any treatment offered is at best guess work and at worst harmful (even if only by giving someone false cause for hope).

Some standalone treatments and therapies can be effective for pain relief but they may not deliver stable results or resolution because they are not dealing with underlying causes, only with pain and symptoms.

Once we have identified the underlying causes of your back pain (and any other symptoms) then proceeding to a treatment and advice plan is an easy step.

We have a wide range of therapies and tools at our disposal to deliver exactly the right combination for you: taking into account your clinical presentation, your personal preferences, and your lifestyle.

We’ve refined our combinations of therapies over the past 12 years with over 12,000 patients, so you can be very confident that our recommendation to you is the very best, evidence-based, option for you.

People who come to us with chronic back pain have often been told by doctors or other practitioners that there’s nothing that can be done for them and they will ‘just have to learn to live with it’.

What they should have been told is – there’s nothing else that I can do for you, but there may be someone else who can help.

We can almost always help. Even people with the longest history of back pain, with failed surgeries, with life-changing injuries, who have ‘been everywhere, tried everything’ find new hope at Core.

Back pain doesn’t have to be part of life, nor is it an inevitable part of ageing. Whilst it’s true that in some very chronic cases we may not be able to fully resolve your back pain, it’s highly likely we’ll be able to reduce the frequency and severity of your pain, give you a greater sense of control over its management, and give you a clear understanding of the dynamics of your pain.

As we’ve explained there are many different combinations of causes that can result in discal changes and associated symptoms. When we see you as a new patient your clinician will evaluate the detailed causes of your condition, give you a diagnosis, and fully explain what’s underlying your specific symptoms. However, as a general introduction, we can explain what is typically ‘going on’ when someone has discal symptoms like sciatic pain.

Sciatica causes an irritating and ‘nervy’-feeling pain that typically spreads from the lower back or buttock area and radiates down into the lower limbs. The pathway that pain ‘radiates’ along is dependent on which part of the spine is the main source of the problem – typically for sciatic pain it will be the lower part of the spine. The pain is typically not generated directly from the bones or discs in the spine but by compression and/or irritation of one or more of the nerve roots in the lower back (where the sciatic nerve itself is situated). Although the start point of the problem could be at a particular level of the spine (e.g. L5 S1 – indicating the section of the spine that clinicians refer to as ‘Lumbar section 5, Sacral section 1) the associated pain and other symptoms might be felt in the lower back, buttocks and/or anywhere in the lower limb. This is due to the nerve pathways that connect the spine to the lower limb, and may be made worse when someone experiencing these symptoms starts to move or hold themselves differently in response to the pain. In addition to pain you might experience additional symptoms including numbness, weakness of your muscles, and difficulty in moving or controlling your lower limb.

Damage or dysfunction affecting the discs between the vertebrae of the lower back are a key part of the mechanism that causes sciatica. The discs are made up of a ‘spongy’ ring of cartilage with a more gel-like centre – which makes them great ‘shock absorbers’. When they are healthy and functional, discs cushion the spine from compressive forces which can come from everyday activity, or injury. However, if discs become worn or damaged – for example, by excessive or poorly controlled rotational movements, unsafe lifting or a sedentary lifestyle with insufficient healthy movement – they may become less effective. This process can manifest in various ways from causing slow deterioration and mild pain, to severe symptoms which can occur very rapidly. Herniation of a disc (sometimes called a ‘slipped disc’) or disc prolapse can occur when the central ‘gel-like’ part of the disc is squashed into the spinal canal; this in turn compresses the nerve which causes pain and other symptoms.

When people have been told by doctors or other healthcare professionals that they have a discal condition they are often left very concerned. While discal conditions can be concerning and they do require careful management, they are usually highly-treatable and a complete recovery is very possible for many patients. Our spines are generally far stronger, more flexible, and more robust than we might imagine.

As we grow and then age, all of our spines are subject to wear and tear, and over time some people’s spines might become more damaged and symptomatic. This is when we might start to experience symptoms like pain, radiating pain, stiffness or restricted movement in our spine or connected areas.

Patients seeking help for these symptoms are often alarmed by terms like ‘herniated disc’ and ‘degenerative disc disease’, and by MRI reports highlighting changes in specific parts of their spine. However, herniated discs can often self correct and be encouraged to heal; disc degeneration is a normal part of ageing and does not cause significant symptoms in many cases. We have significant experience of successfully helping patients who have these types of conditions and symptoms with entirely non-surgical, non-pharmaceutical, tried and tested treatment approaches.