Proven approach to the treatment and prevention of back pain and sciatica
Of all the health-related problems we have helped our patients with over the years, back pain is our area of greatest expertise and success. We are especially known for helping patients who have had back pain (often combined with other areas of pain) for many years and who have ‘tried everything’ before coming to us.
There are few chronic conditions more debilitating and distressing than back pain.
Even a relatively short-lived bout of back pain can be both incredibly painful and worrying.
Back pain also has a reputation for being mysteriously difficult to diagnose, notoriously difficult to treat, or just something you have to learn to live with as you get older.
At Core Clinics, we disagree with all of these back pain myths. We specialise in the treatment of chronic complex back pain that has not been resolved by other treatment approaches.
Sub-conditions and symptoms we can help with
Of all the health-related problems we have helped our patients with over the years, lower back pain is our area of greatest expertise and success. We are especially known for helping patients who have had back pain (often combined with other areas of pain) for many years and who have ‘tried everything’ before coming to us.
Lower back pain is very common; most people will experience it at least once in their lifetime and it’s the leading cause of days lost due to disability. Lower back pain is often experienced alongside hip pain or knee pain and, indeed, they are often related with one causing the other.
Often lower back pain comes on quite suddenly and resolves quickly with simple self care. This is known as ‘self-limiting back pain’. However, if the pain is very intense or accompanied by other symptoms, it can still be very distressing. In some rare cases a sudden onset of severe back pain can signal a medical emergency. We are always happy to give advice and reassurance if you are suffering with a sudden flare up of lower back pain.
In other cases people can experience back pain over a long period of time or recurrently, which can be debilitating. Chronic lower back pain is often accompanied by other back symptoms like stiffness, tightness, or pain radiating down the legs – which is a symptom commonly associated with sciatica or discal problems.
Pain associated with sciatica or discal conditions can be severe and distressing. While these conditions need careful management they are generally very treatable with conservative care. In other words, we can achieve significant improvement and often complete resolution of these conditions without any kind of surgical or pharmaceutical intervention. Very often people who are diagnosed with sciatica or disc problems are never told why – what are the causal mechanisms that have caused their disc to become herniated or damaged?
By identifying why, we can then successfully identify how to treat.
We see a lot of patients in the clinic who have sciatica, sciatic-type pain, and problems affecting the discs in their spine.
You may have been given a diagnosis for these types of conditions by a doctor or another healthcare professional before you come to see us, or you may have symptoms that seem to suggest a discal problem or point to a diagnosis of sciatica.
However, it is very common for people to be misdiagnosed with sciatica when they have sciatic-type symptoms – classically, when pain or other symptoms radiate from the lower back or buttocks area down the leg.
There are different conditions that can cause these types of symptoms – for instance, piriformis syndrome – which would require a different treatment approach than ‘true’ sciatica, because the two conditions have different underlying causes.
Therefore it is very important that we start with a full evaluation of your symptoms, medical history, and a comprehensive examination before arriving at a specific diagnosis and recommending the most beneficial treatment approach for you.
If simple pleasures like picking up your grandson, doing the garden, or walking round your favourite city, are affected by general aches, pains, or stiffness in your back, you don’t have to just learn to live with it. We can give you self care advice and simple treatment plans to help make your back – and your body overall – feel freer, stronger and more supple.
As we age and depending on our general health and lifestyle we can become more vulnerable to conditions like osteoarthritis and osteoporosis. The larger weight bearing joints of the spine, hips and knees commonly affected which can result in significant pain, loss of mobility, and increased fragility. There’s a lot that you can do to reduce the risk and impact of these types of age-related conditions and we can offer advice on nutrition, movement and exercise, and therapeutic support to help you keep feeling younger for longer.
To direct you to the best practitioner for your initial appointment we’d first ask how long you’ve been experiencing back pain, or episodes of back pain. You can also check out our practitioner guide (link to how we work page) or contact us (link to contact us) for assistance.
A sudden flare up of back pain can be very painful and alarming, but it’s good to know that it rarely indicates a serious problem. Most short-lived back pain is ‘simple’ or ‘mechanical’ which means it’s not related to any underlying condition.
If you are suffering with back pain which has started quite recently (within the past couple of months) and is not causing you significant distress, we’d suggest that you book an initial consultation with one of our sports therapists or physiotherapist. They are all highly trained and experienced to conduct an assessment and, if there are no significant underlying issues, they’re likely to be able to treat you and to achieve a significant improvement within a matter of weeks.
If your initial assessment indicates that your back pain has a more complex underlying cause, your therapist may consult with our Clinical Director or recommend that you see one of our chiropractors or another member of the team who is best placed to help you.
Back pain is often self-resolving (meaning it will get better by itself or with simple home care) but for many people it can recur and become chronic. Once back pain becomes chronic there are usually several underlying reasons for it, which is why ‘standalone’ treatments that don’t identify and deal with underlying causes, can be ineffective.
Our clinic specialises in treating chronic, complex back pain (complex just means with several underlying causes or additional symptoms) so you can be confident we will get to the bottom of your back pain and devise a plan to address it.
If you’ve been suffering with back pain, sciatica, or a related complaint for quite some time (several months or even several years or decades) and you’ve tried other treatments without lasting success, we’d recommend that you book an initial assessment with one of our chiropractors. Chiropractors specialise in treating back pain and at Core Clinics, our chiropractors specifically specialise in treating chronic back pain.
The longer-standing your back pain is and if you have other health issues as well as back pain, the more likely it is that we will recommend an ‘integrated’ treatment protocol. This might involve you having appointments with several members of the team initially – for example, chiropractic, sports therapy and podiatry. We’ll explain our full findings and recommendations for you after your first appointment as well as letting you know what results you can expect to achieve.
Our treatment programmes for sciatica and for conditions which have similar symptoms typically include chiropractic and / or osteopathy and soft tissue and rehabilitative treatments (e.g. massage therapy, physiotherapy) along with IDD therapy which is a computer controlled highly targeted traction therapy for discal conditions.
How we can help you
Comprehensive consultation, examination and health history
Treatment plans and therapies
A clear diagnosis with recommendations for self-management and treatment protocols
Tailored to your needs
We work in partnership with our patients to deliver consistent results, with regular reviews and follow ups
How we work
Multi-disciplinary patient-centred healthcare
Lots of clinics have different healthcare professionals under the same roof but they don’t tend to collaborate fully or share care with patients. They also don’t have clear and proven care protocols which have been tested and refined to provide the best possible results, and value for time and money for patients. At Core Clinics all our clinicians and therapists work in an integrated way, adapted to the needs of each patient. So, when you make a first appointment with anyone in our team, you’ll have access to everyone in our team – and we’ll clearly signpost to you who you should see and what you can do to help yourself too. We’ve developed and refined this approach for over 15 years and helped over 13,000 patients.
Don't just take our word for it
We have helped thousands of people to achieve a better state of health, or to reach their sports performance goals.
Back pain and sciatica
Frequently asked questions
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.
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Core Clinics offer a unique, integrative approach to health and wellbeing and sports performance.
We leave no stone unturned to get to the bottom of your health issues and answer all your questions.
Treatment plans and therapies
We’ll give you a very clear diagnosis and prognosis so that you know exactly where you stand and what you can expect from working with us.
Tailored to your needs
We’ll explain in detail our recommended treatment approach and give you lots of advice for self-care. If we feel you’d be better served with another clinical professional, we’ll let you know and arrange a referral.
Let us know how we can help
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