Back pain, explained

Back pain is extremely common but there are surprising misconceptions around the causes. Mr Chris Brown, an expert spinal surgeon at Circle Reading Hospital, aims to set the records straight

Around 80% of us will experience back pain at some point in our lives. When it becomes persistent or particularly intrusive, many will seek medical advice to assess the underlying causes.

The early distinction that needs to be made is whether it’s mechanical back pain, from structures such as the discs and facet joints in the back, or if it’s nerve-related pain. Let’s look at both in more detail…

Patterns of pain are key

To reach a diagnosis, assessing the pattern of pain is key. I will look at whether the pain is focused around your back or legs, the range of movement across your spine, and whether your nerves are all working fully. By doing relatively simple tests, I can then define if it’s a mechanical pattern or from the nerves. I may also recommend particular scans, such as an MRI scan, to confirm a diagnosis.

There are also other clues during the assessment. Disc pain is often made worse in activities involving leaning forward, whereas pain from the small joints of your back, called facet joints, is often amplified with leaning back.

When we look at nerve pain, the key thing is the intensity of the pain. A lot of people with back pain will have had it for years and feel they’re able to cope. Add on nerve pain to this and it often feels far more severe.

Nerve pain is often associated with other symptoms such as numbness and pins & needles. For it to be defined as sciatica, the symptoms need to include below the level of the knee.

Likely causes of persistent back pain

The vast majority of the cases relating to back pain don’t follow any traumatic injury or accidents.

You use your back day in, day out so there is constant strain being applied in nearly everything you do. Activities like bending down, lifting objects and even just sitting down awkwardly can make it vulnerable. Combined with natural degenerative changes over time, this strain can lead to pain.

There are certain sports such as gymnastics and tennis that can cause particular patterns of pain. In general however, doing a regular sporting activity that contributes to your overall fitness is the very best thing to do for long term spinal health.

Most back pain has a genetic component to it, as it tends to run in families. However it can be brought on, or made worse, by particular activities. For instance, pain from the discs in your back can be made worse by prolonged periods of sitting, whereas nerve pain is often intensified by longer periods of standing or walking.

Common misconceptions

By far and away the most common misconception is that there is a serious cause to back pain. Quite often it can come on suddenly, so it’s completely understandable people are concerned, especially if the pain is intrusive.

Serious causes such as tumours and infections are a very rare cause of spinal problems, but a thorough consultation will ensure any red flags are picked up and investigated.

Secondly, many people believe you should avoid movement when you have back pain as they’re afraid of causing further damage. This is absolutely not the case. In most cases it’s very important to try and stay active.

Finally, if you book a consultation with a spinal surgeon, many people believe they’re bound for surgery. There are many simple and effective measures which can help to make things better, so surgery is rarely needed for spinal problems. Treatments can range from lifestyle changes, physiotherapy, and pain management programmes before surgery is considered.

A key part of my role is providing reassurance after a diagnosis, explaining what’s causing the pain and then opening up all possible treatment options to get you on the road to recovery.

It’s quick and easy to book a consultation

If you’re suffering with back pain, we can quickly book you in to see a back specialist at Circle Reading Hospital. Whether you’re paying for your own treatment, or using private medical insurance, get in touch to see how we can help.

Call us on: 01189226888

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Circle Health, 32 Welbeck St, Marylebone, London W1G 8EU