Types of back pain
Low back pain
Low back pain will affect a high percentage of us at some point in our lives. In fact, worldwide, low back pain causes more disability than any other condition. When it’s not possible to identify a particular cause this is called ‘non-specific’ low back pain, so it can be challenging to reach a diagnosis. It will usually improve over the course of several weeks or months, but it can still be frustrating to live with and disruptive to your everyday life.
When we talk about low back pain, we are referring to our “lumbar” region which has five vertebrae. Each of these has a label from “L1” up to “L5”, the latter sitting at the bottom of your spine. In between these vertebrae are discs which are the shock absorbers to support and cushion your spine. It’s usually L4 and L5, your lowest vertebrae, which get injured as they take the most force and pressure during everyday life.
What is meant by the term mechanical back pain?
This term is a widely recognised term within healthcare to describe pain which has no obvious structural cause found on diagnostic tests such as blood tests, X-rays and MRI scans. This umbrella term describes the vast majority of cases of spinal pain which as the name describes are aggravated with certain movements or postures such as flexing forwards, standing or sitting for prolonged periods.
Is back pain a sign of serious medical problem?
In the vast majority of circumstances, back pain is due to mechanical symptoms as described above. In rare cases, there may be more serious medical causes of back pain.
Immune system problems known as autoimmune diseases may also give rise to joint inflammation and in many cases, may affect the lower spine and pelvic joints early in the disease process. The most common of these is a condition known as ankylosing spondylitis but psoriatic arthritis and infective or reactive arthritis are also possibilities.
Infections within the discs or vertebral bodies as well as the spinal canal are very rare but exist. In these cases there may have been a precluding illness or known infection elsewhere in the body.
Rarely, certain types of tumours can arise around the spine. The spread of other primary types of cancer known as metastases commonly affects the spine and pelvis.
Unlike other body areas normally benign problems such as cysts and degenerative changes to joints and soft tissues can become serious if these problems begin to encroach upon and compress the spinal cord. This problem is sometimes termed myelopathy and if not surgically managed may result in significant disability.
In general it is good practice to seek a clinical opinion if your symptoms do not appear to be aggravated and relieved by postures or movements. If you feel unwell, have a temperature or weight loss, have previous or current medical history of autoimmune disease or cancer or you have developed significant numbness or weakness anywhere in the body these all necessitate an urgent clinical opinion.
How do I treat coccyx pain?
Coccyx pain may develop due to a known risk factor or may occur with no obvious cause. There are two different types of coccyx pain. The first is pain on the tip of the coccyx which may be caused by sitting directly on firm surfaces or a direct injury to the tip of the coccyx such as falling backwards. This can also aggravate existing pain further.
The second type of coccyx pain arises from the fibrous connection between the middle part of the pelvis known as the sacrum and the coccyx. Causes may again include direct impact trauma to the coccyx area but may also occur from genetic or hormonal influences which may make this fibrous connection weak. Common examples are pregnancy and also genetic hypermobility syndrome.
Treatment of both forms of coccyx pain is referred to as coccydynia, and relies on relieving the pressure on the coccyx for a prolonged period of time to allow the inflammation to settle or the sacrococcygeal joint to stabilise. To relieve this pressure specialist seating cushions are used which may be wedged or flat but always contain a cut out section. In cases which have not responded to appropriate seating modifications, pain clinics may offer an anti-inflammatory injection to the painful part of the coccyx.
In some cases where it is thought the sacrococcygeal connection has been partially dislocated or misaligned, a manipulation may be considered.
Which specialists can manage my back pain?
Various types of specialist are available to treat back pain and picking the right clinician to see can be a challenge. But within your initial consultation the appropriate next steps for any treatment that may be required are quickly set out.
Orthopaedic doctors are surgeons who normally deal with problems with the musculoskeletal system i.e. joints, ligaments, muscles and bones. Spinal orthopaedic surgeons see patients with a wide variety of problems which may require operating.
Often the spinal orthopaedic surgeons and neurosurgeons operate on many similar spinal problems. However, some specialist forms of posture correcting operations and spinal fusions that the orthopaedic surgeon may exclusively deal with and specialist nerve decompressions that the neurosurgeon may deal with.
When rehabilitating the spine there are a range of spinal rehabilitation professionals which include musculoskeletal and orthopaedic physiotherapists, osteopaths and general physiotherapists. Within mainstream healthcare the rehabilitation element to caring for spinal conditions is almost always managed by physiotherapists.