Introduction
Lower back pain is very common and according to the World Confederation of Physical Therapists, is the number one cause of disability across the globe. Only 1-5% of all lower back pain is attributed to serious disease or injury and it is one of the most frequent issues patients attend our clinics seeking professional input and support.
There is a complex network of soft tissue structures in the lower back which may contribute to your symptoms including muscles, nerves, tendons, ligaments, joints, inter-vertebral discs and connective tissue. At Pure Physiotherapy, our skilled practitioners can identify specific structures that may be a contributing to the symptoms experienced.
Sciatica
Together with lower back pain which can gradually worsen or come on suddenly, it is common for patients to report symptoms spreading into the buttock and leg, sometimes as far as the foot. This condition is usually indicative of sciatica which is an umbrella term used in the medical world describing irritation of the nerves which exit through holes between each spinal bone of the lower back to supply our legs. These nerve roots are extensions of our spinal cord and form our peripheral nervous system, sending electrical impulses throughout our limbs. To reach our limbs, the nerves branch out of the spine in gaps between each vertebra called foramen. Approximately one third of the space at each foramen is taken up by the nerve root, leaving plenty of space.
Through mechanisms including inflammation, swelling, age-related changes and trauma, the pressure around where each nerve root exits from the spine can become irritated. This pressure around the sensitive nerve root may affect all the various branches it supplies, helping to explain symptoms experienced into buttock and further down the leg.
Precautions
As well as pain, altered sensation in the form of pins and needles or numbness can also be a symptom of sciatica and tends to be provoked with movements/actions which put more pressure on the nerve roots. It is important to note that if you experience worsening symptoms in both legs and you are losing power and function in your legs without pain, we recommend you seek urgent medical advice and attend A&E. Also, if you are experiencing significant changes in your bladder, bowel and/or sexual function or sensation, we also recommend that you attend A&E as this relates to a rare but serious medical condition known as cauda equina syndrome which although is a very rare occurrence, may become permanent if not addressed urgently.
More Information
Many of our patients visit with the hope that an X-ray or MRI may help establish the cause of their symptoms. Other than in specific circumstances where imaging may be helpful to inform the medical or emergency management of your condition, they are rarely required. Research has demonstrated that very rarely do scans match up with symptoms, it doesn’t benefit treatment, results tend to be unclear or misleading, it costs the health system and may make you worse and could increase the likelihood of ineffective treatment. There are occasions where imaging or further investigation may be appropriate. Should this occur, your Physiotherapist at Pure will give you a clear explanation of how this will help your recovery and modify your treatment direction. The video below, supplied by the Chartered Society of Physiotherapists gives a great overview of managing back pain.
Your Assessment
Our skilled and experienced Physiotherapists and Pure will carry out a detailed history and thorough physical examination to provide you with information on the structures affected and an accurate diagnosis.
Treatment & Management
Following diagnosis, your Physiotherapist will explain what is most likely contributing to your symptoms and will work with you to create an individualised home exercise and self-management strategy. Below are some mobility and strengthening exercises we recommend
Your Physiotherapist will equip you with the knowledge and skills to effectively manage your symptoms and support you in your recovery. By working closely with each patient, our Physiotherapists at Pure can understand what is important regarding your limitations and important activities so that the management plan is directed towards achieving full function.
In combination with the exercises and self-management strategies, Your Physiotherapist at Pure may provide complementary hands on treatment.
Our Physiotherapist will use targeted soft tissue mobilisation techniques and manual therapy to reduce the pain in the affected structures, help improve movement and promote optimal healing. A vast majority of our clinicians are also trained in acupuncture which involves the insertion of medical-grade needles into specific anatomical sites as another modality for reducing pain and optimising healing.
