Management of back pain

In general, the options for managing back pain include a stepped approach to care, meaning that the least invasive treatment options are considered first, and the least invasive treatment options are considered when less risky interventions have failed.

For most patients suffering with back pain, two treatments of choice will be period of sensible activity modification, appropriate over the counter analgesia and physiotherapy. Physiotherapy is effective for managing back pain in a variety of ways.

Expert physiotherapists at Circle Health are able to provide a comprehensive and analysis of the causes of back pain in the first instance. This enables them to tailor a flexibility program for and other soft tissue around the spine, hips, and shoulders as appropriate.

From the comprehensive biomechanical analysis that Circle Health physiotherapists provide they are also able to advise on appropriate strengthening and conditioning programs for spine as well as modifying technique for activities of daily living and sports where appropriate.

Once you are back to your full activities or playing sport again, our expert spinal physiotherapists will also be able to advise you on the best ongoing maintenance routine to prevent further relapses of to your full activities or playing sport again our spinal physiotherapists will also be able to advise you on the best ongoing maintenance routine to prevent further relapses of any spinal pain.

In cases where physiotherapy has been found to be ineffective at relieving pain and improving patients function, there are some alternative pain management solutions which may be of benefit.

Injections can be helpful in certain cases, especially when there are demonstrable signs of degeneration and especially where there are demonstrable signs of inflammation on an MRI scan. Inflammation particularly of the facet joints, may respond well in the short to medium term with a corticosteroid injection.

If injections have provided reasonable short to medium term relief a longer term solution may be offered in the form of denervation procedures which work to eliminate the pain receiving signals from the affected joints.

Other specific cases where corticosteroid injections may work to reduce inflammation is when a scan has demonstrated what are known as Modic endplate changes. In this case, what is known as a caudal epidural injection may be considered. All injections at Circle Health are completed with x-ray or CT image guidance to ensure the best possible outcome is achieved.

Lastly, surgery may be considered in cases when there is intractable spinal pain which has not responded well to pain management interventions. Most operations for spinal problems are what are termed decompression operations which aim to relieve compression on the spinal cord or nerve roots.

Unfortunately, this is a surgery does not address back pain its self and is only undertaken to reduce pain which radiates into the limbs. The types of surgery for back pain itself are fusion surgeries which are even more invasive.

As a result, these operations are rarely undertaken for back pain alone. Our specialists at circle health will be able to provide you with all of the necessary information at every stage of your treatment so the best possible intervention(s) are undertaken for you.

Circle Health has experienced spinal physiotherapists are able to accurately diagnose and assess the reason for each patient's back pain. As a result, our patients' rehabilitation exercise plans are not only effective but in entirely safe.

Risks of corticosteroid injections are extremely minimal and less than 1% in percentage terms. The main risks associated with injection therapy are:

  • Increased pain which may last up to 12 to 24 hours post injection
  • Infection which is extremely rare and normally documented as less than 1:10-100,000
  • Allergic reaction to the medication used known as an anaphylactic reaction. This too is extremely rare and the incidence is less than 1:100,000
  • With certain spinal injections there can be a risk of patients suffering from a low-grade headache in the days following the injection

The risks associated with any spinal operation are clearly much greater than those with physiotherapy and spinal injections. These will be discussed in detail with you by your surgeon prior to your operation and can include:

  • Failure of the metalwork and bone graft to fuse at the operated level
  • Persistent pain at the site of the bone graft (normally the iliac bone at the pelvis)
  • Progression of spinal disease especially at the adjacent spinal joints which may have increased loads and movement placed on them due to the fusion
  • Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
  • Blood clots are possible after any operation and are more common in patients with some pre-existing medical conditions. However, again they affect a very small percentage of patients and have well established treatments including aspirin.
  • In rare circumstances patients, may suffer a stroke as a result of a blood clot developing.
  • Damage to the nerves in the cervical spine or lumbar spine which may result in sensory loss and weakness in the arms and/or legs and in extreme circumstances loss of bladder/bowel/sexual function.
  • The intended benefits of reduced pain and increased function may not be felt.

The recovery time for back pain depends very much on the specific condition. Circle Health will always run diagnostic tests alongside our clinical evaluation to ensure an accurate spinal diagnosis is made prior to starting treatment.

Episodes of acute low back pain in individuals who have never suffered with spinal problems, may last several days and may take several weeks for individuals to regain full spinal mobility and strength. For individuals who have suffered previous episodes of LBP their recovery may take longer. Our expert spinal clinicians will take in to account the patient's individual circumstances and tailor their treatment accordingly.

The time frame for recovery following a spinal injection is normally very quick. There may be some post injection soreness for 12 to 24 hours post injection but then patients will often feel improvements and function returning for up to 4 to 6 weeks.

Following spinal surgery for back pain, during the first 6 to 12 weeks patients will be able to return to a sensible, independent standard of living at home ensuring they do not push their activities too much too early. Walking around the house and up to two miles per day outside are sensible activities.

Patients are normally asked to ensure they don't stay in one position for too long, i.e. prolonged sitting or standing may increase pain levels during the initial period of time after a spinal operation. Any weight lifted during the initial 6 to 12 weeks should weigh no more than a kettle.

In spite of these activity restrictions most patients can expect to feel a significant reduction in their pre-operative pain levels very early on as the painful spinal segment or the spinal segment responsible for the nerve compression has now been fused.

After the initial 6 weeks, Circle Health's expert spinal physiotherapists will work closely with you to expedite your recovery. Aims of rehab will include:

  • Increase strength in your spine
  • Increase balance and co-ordination
  • Where necessary prepare you for a return to sports & other higher level activities.


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Circle Health Group, 1st Floor, 30 Cannon Street, London, EC4M 6XH