Why does my back hurt?

Did you know that around 85% of all cases of back pain have no known cause?

Contortionist_Ravi_standing

Specialists call these “non-specific” or “mechanical”. “Mechanical” because pain is typically aggravated or relieved by a particular movement or position, such as bending forward or standing still. Non-specific back pain can range from mild aching and stiffness to severe and disabling pain.

At one time, specialists believed that back pain was due to injury or “wear and tear”, visible on X-rays or scans. Now we know that signs of disc injury or wear and tear are very common and have only a very weak relationship to pain.

The mysterious nature of idiopathic back pain is a real problem. Sufferers often go to their GP, who often feels under pressure to provide some sort of explanation. Unfortunately this is sometimes “it’s your age” or “wear and tear” when in fact it’s neither of those. Often people with back pain are referred for an X-ray or MRI scan if it’s not getting better. If the report comes back saying the back is normal, you could be left with the impression that either your back has some sinister undiagnosed disease, or you are complaining for no good reason. If you get to read the report, you might be lead to believe that normal wear and tear indicates your back is damaged and weakened. Not a happy situation.

Most cases of back pain can’t be diagnosed by MRI, X-rays or even blood tests. However, these can be useful to rule out more specific conditions. So what does cause back pain in most cases? How can you get a painful and disabling condition without disease or injury?

Well, there is a third alternative to disease and injury: dysfunction. That is, the tissues are basically healthy but the organism is in some way uncoordinated, and that puts strain on tissue, leading to symptoms: pain and stiffness.

But how can the back become “uncoordinated”, and how does that lead to pain and stiffness? The thought that the back (or the body in general) could let you down like that is rather unsettling! You have to remember that the body, like everything else in the physical world, must obey the laws of mechanics. When designing a mechanical device, an engineer is faced with certain trade-offs and needs to find the right balance. In the case of the human body and the spine, evolution/God (take your pick) has also had to ‘decide’ between stability and adaptability.

redundant chain

‘Redundant’ chain-like structures such as the spine have many ways of to carry out the same task.

This leads us to how “redundancy” is used in the design of mechanisms. Redundancy means having more than one way to do the same thing. Consider the design of spacecraft. Unlike cars, they have many layers of redundancy built in because you can’t just call out the AA if it breaks down. So, for example, the NASA Curiosity rover has six wheels instead of four, each with its own engine.

Similarly, the human spine has a ridiculous number of joints in it – 74, not including the joints between the spine and the ribs. No-one ever needs that many joints, not even for the most extreme contortionist’s party trick! Think how many joints you actually need for bending forward – you only really need one hinge joint. No engineer in their right mind would design a crane, for example, with 20 hinge joints. It would be grossly unstable unless you had a very sophisticated control mechanism, sharing out the load just right.

On the other hand, the problem of building a crane with just one hinge joint is that if that joint seizes up the crane will not work at all. But if you have two, you can use the control mechanism to change the motion pattern, which will allow the crane to carry on working. Here lies the benefit of having a spine with so many joints. There are many people walking around with worn-out intervertebral discs who have no back pain or stiffness. Their spines have adapted happily to this change.

Unfortunately, the spine doesn’t always adapt in such a way that it can carry on regardless. The fact that it can move in an infinite number of ways also means that it has the freedom to move in ways that put excessive load on certain parts of the system. It can also fail to coordinate properly so that the muscles are working against each other, leading to painful spasm. Muscle is often the immediate source of the pain in these cases because it has the ability to cut off its own blood supply. When a muscle contracts, the pressure inside the muscle rises and it doesn’t take much for that increased pressure to counteract the weak pressure pushing the blood through the muscle. If a muscle stays contracted for too long, the lack of oxygen will lead to pain and stiffness.

These cases of back pain are like an engine out of tune. If you were to take an engine that is out of tune and X-ray it, or even take it to pieces, you wouldn’t find anything wrong with it. But if you were to run it, you would hear that the engine was not coordinating properly, causing strain and back-firing.

Osteopaths aim to restore normal function to sort out the back problem. We make extensive use of palpation (locating and assessing painful areas by touch) and observation to detect things like muscle tightness, shortening, uneven distribution of spinal joint motion, imbalance of muscle activity and so on. Through advice on movement and posture, exercises, manual treatment of tight tissues and joints we aim to get the engine back in tune.

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How being let down by friends helped me finish a marathon

My flaky friends helped me finish first marathon

Olympic Park, down-town Amsterdam, October 2004. Weather is damp and the sky an unending vista of grey.

The 20mile training runs, the hill work, the sprints are done. The hours minimising injury and reducing niggles by enduring osteopathy and sports massage sessions are over.  I’ve tapered well to make sure my glycogen stores are brimming. I’m feeling both excited and nervous on the start line.  One refrain, however, rattles around in my adrenalin soaked brain – don’t go off too fast!

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Do I need a new mattress?

If we had a fiver every time someone asked us this…!

bed3The first thing is, do you really need a new mattress? After all, they are not cheap. Good sleep is important with any muscular condition, as muscles regenerate during deep sleep. Deep sleep is also important for the immune system. If you find you’re dreaming a lot, you might not be getting deep sleep, and a good mattress might be what is required. Some other indications that you might need a new one are these:

  • You often wake up in the morning with pain and stiffness. This symptom is not necessarily caused by a bad mattress, but if you find that your back feels less uncomfortable on another bed, that is quite a strong indication.
  • Your mattress is more than 10 years old. If it’s a cheap mattress, it will probably not last as long. Also, if it hasn’t been turned regularly, it might lose its consistency prematurely.
  • The mattress has lumps, or is dipping. It has definitely had its day!

So let’s say you do need a new mattress. Which one should you go for? An ‘orthopaedic’ mattress? Unfortunately, the term orthopaedic, when used in reference to mattresses, is just marketing hype. It does not mean it has been recommended by orthopaedic specialists, and it may well be too hard for you. It’s a myth that you should sleep on a hard surface if you have back pain. Some people may feel better after sleeping on a hard surface, but it is not a general rule.

How about memory foam mattresses? Opinions are divided here, and there seems very little independent research to support their use. In general, we don’t recommend them. They tend to make the body to ‘nest’ too much. In other words, the mattress moulds to the shape of your body making it more difficult to move into another position. If you see films of people sleeping, speeded up, you will see they move quite a lot. Also, many people complain that they make them feel too hot at night. Those who are predisposed to pressure sores, due to medical problems, may possibly benefit from a memory foam mattress.

So which mattress should you choose? The most important thing is to go to the shop and try it yourself. Generally we recommend a well-made, standard mattress from a good manufacturer. Look for a mattress that has a long guarantee. These are usually constructed using springs. Here are some tips when testing a mattress:

  • Try leaning your weight on the edge of the mattress. A cheap mattress will not support your weight, and it can be difficult getting out of such a bed if your back is hurting.
  • Lie down on the mattress for at least 30 seconds in your usual sleeping positions to get a good feel for it.
    Roll from side to side. You should move easily without feeling your shoulder is pressing hard into the mattress (too hard), or feeling like you are trying to roll out of a dip (too soft).
  • Lie on your back. Feel under your low back. If it is floating in the air the mattress is probably too hard. If it sags into the mattress, it’s probably too soft.
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Our very first blog post!

Welcome to our first blog posting which comes at the end of quite a year for us at First Call Osteopaths:

  • We celebrated 10 years of being in our current location in Oakwood, N14
  • We rebranded
  • We changed our name to reflect the fact that we wanted to concentrate more on osteopathy as our core service
  • My NHS osteopathy contract came to an end – watch out for my blog post about my experience of working as an osteopath in the NHS
  • We are currently in negotiations with a very experienced and highly-qualified osteopath and researcher to come and join the practice

We’re really proud of the fact that despite the difficult economy we have been able to increase the number of new referrals by personal recommendation.  However, we know that we cannot afford to be complacent and that we need to keep moving forwards to improve standards of care for our patients.

So what are our priorities for 2015 and beyond?

  1. We want to embark on a marketing and PR drive to get osteopathy better known within the local medical community in Barnet and Enfield.
  2. We want to try and create a hub for local osteopaths in North London so that patients (and us osteopaths) know what our particular areas of expertise are.
  3. We want to increase our knowledge base and skills by doing more clinical audits and research into our areas of interest.

It feels as though we at First Call Osteopaths are embarking on an exciting new phase of growth and I’m really looking forward to sharing our ideas, insights and developments with you in this blog. With best wishes, Vinod Mahtani Founder and Principal Osteopath at First Call Osteopaths.

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