Back Pain

Back pain is a common problem which affects 4 out of 5 of us at some point. It’s often caused by a simple muscle, tendon or ligament strain and not usually by a serious problem.


During the course of this year, 16.5 million people in the United Kingdom will rely on drugs, physical therapy, the scalpel, or any number of medical procedures, to manage their back pain.


Back pain can be acute, where the pain starts quickly but then reduces after a few days or weeks, or chronic, where pain might last on and off for several weeks or even months and years.


In a typical National Health Service year up to 7 million patients will consult a GP because of back pain. Of these, 1.6 million will be referred to consultants in hospital out-patient departments, and 100,000 of these referrals will be admitted to hospital. Just under a quarter of the referrals, around 24,000 patients, will have surgery to treat their back pain.


The symptoms of simple back pain often occur suddenly and can be triggered by a particular movement, but the causes may have been building for some time. Today 1.3 million new people in the UK are wondering what’s wrong with them and if they will ever be pain-free again. There is good news: these days there are options starting with the services of The City of London Chiropractor Back Pain Clinic.


Structure of the Back


The back is a complex structure consisting of:


  • 24 small bones (vertebrae)
  • Shock absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend
  • Ligaments to hold vertebrae and discs together
  • Tendons to connect muscles to vertebrae
  • Spinal cord (carries nerves from the brain to the rest of the body)
  • Nerves
  • Muscles


All structures in the back can be damaged by different actions and events. Your City of London Chiropractor will be able to identify the structure precisely and discuss the potential cause.


Causes of Back Pain


Some of the most common causes of stress and strain on the spine include:


  • Poor posture – slouching in chairs, driving in hunched positions and standing badly
  • Lifting incorrectly
  • Sleeping on sagging mattresses
  • Being unfit
  • Generally overdoing it – over tiring muscles and not using a gradually increasing work or sports programme. Not warming up or cooling down before and after exercise will also cause muscle pain
  • Inactivity and the wrong sort of movement are usually at the root of simple back pain.


Inactivity makes the muscles go slack and weak so they are unable to support the back properly. This leaves the back more vulnerable to damage when certain movements put too much strain on one area.


Often, the problem is caused by a strain or tear to the muscles, tendons or ligaments around the lower spine. In turn, this can produce painful muscle tension and spasm.


Even a minor problem can cause a lot of pain when you stand, bend or move around. Pain sometimes comes on suddenly, sometimes gradually, but usually it only lasts a few days or up to a week.


Work Related Back Pain


The spine is not suited to sitting in front of a computer or behind the wheel of a car for long periods. Poor posture plus lack of muscle strength and sitting for long periods in one position will result in muscle spasm and pain. Stiffness may occur as the muscle fibres become inflamed and stick together or there is local swelling. Awkward movements and bad posture cause musculoskeletal disorders which affect the full length of the spine, from the neck to lower back, as well as the shoulders, arms and fingers.


Types of Back Pain


Non-specific low back pain


This is the most common type of back pain. About 19 in 20 cases of acute (sudden onset) low back pain are classed as non-specific. This is the type of back pain that most people will have at some point in their life. It is called non-specific because it is usually not clear what is actually causing the pain.


It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small facet joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests.


Nerve root pain – often called sciatica


This occurs in less than 1 in 20 cases of acute low back pain. Nerve root pain means that a nerve coming out from the spinal cord (the root of the nerve) is irritated or pressed on. Many people call this pressure a trapped nerve. You feel pain along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot. The pain in the leg or foot is often worse than the pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.


About 9 in 10 cases of nerve root back pain are due to a prolapsed disc – often called a slipped disc. A disc does not actually slip. What happens is that part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc. The prolapsed part of the disc can press on a nerve nearby. Other less common conditions can cause pressure on a nerve to cause nerve root pain for example piriformis syndrome.


Cauda equina syndrome – rare, but an emergency


Cauda equina syndrome is a particularly serious type of nerve root problem. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus: problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the anus), and weakness in one or both legs. This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. Go to A and E immediately without passing GO if you suspect cauda equina syndrome.


Tests for Back Pain


Rarely you may be asked to have a further investigation. X-rays however are often unhelpful for two reasons:


1. Most back pain involves the soft tissues of the back (such as the muscles or ligaments) and these can’t be seen on an x-ray.


2. Some wear and tear changes in the bones and joints of the back are common as we age, and although these changes are visible on an x-ray, they’re not often related to back pain. Lots of people who don’t have back pain still show these changes on x-ray.


Beware of clinics who offer x-rays as part of a deal as they are generally not required but form part of a marketing and information giving process.


At The City of London Chiropractor Clinic we do not take x-rays for this very reason but prefer more advanced investigations. Your City of London Chiropractor may send for tests if you’ve had an injury to your back and suspects that there may be an underlying cause for your pain, or if the pain has lasted for an unusually long time. In this case a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan may be needed. On occassion your chiropractor may also request some blood tests.


Serious Symptoms in Back Pain


There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:


  • a fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling of the back
  • constant back pain that does not ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • pain caused by a recent trauma or injury to your back
  • loss of bladder control
  • inability to pass urine
  • loss of bowel control
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night


References: –


Maniadakis A., Gray A., ‘The economic burden of back pain in the UK’ Pain, 2000, 84, 95-103


Palmer T., Walsh K., Bendall H., Cooper C. & Coggon D., ‘Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years’ British Medical Journal 2000, 320, 1577-1578


Carter J.T., Birrell L.N. (Editors), principal recommendations, ‘Occupational health guidelines for the management of low back pain at work’, Faculty of Occupational Medicine, London, 2000


Clinical Guidelines for the Management of Acute Low Back Pain Royal, College of General Practitioners, 1999


The Prevalence of Back Pain in Great Britain Department of Health, 1998


Balague et al, Non Specific Low Back Pain in Children and Adolescents: Risk Factors Eur. Spine Journal, 1999, 8 429-438