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7 – Spinal Pain

One of the top ten sporting injuries!

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Introduction

Although spinal pain is much less common among athletes than among the general populus, it can still affect runners, cyclists, golfers and tennis players. It is important to remember that there are different reasons for lower-back.

  • JOINT PAIN
  • MUSCLE PAIN
  • PROLAPSED DISCS
  • SCIATIC PAIN

Joint pain in the spine

Fact Joint Pain

Typical Symptoms; Local sharp spinal pain with associated muscle guarding. This condition can refer into the mid-back, lower back and groin, hip and sometimes upper thigh. Pain usually appears with specific movements as the joint is engaged (such as twisting and leaning back)

Ignoring soft tissue structures, the spine is comprised of three basic repeating elements. These include firstly the fundamental building blocks of the spine, the vertebra, secondly the small joints that join these together, known as facet joints, and thirdly the shock absorbers that provide a cushion between each vertebra (or intervertebral discs).

Facet joints are important for movement and flexibility in the lower back (lumbar spine) mainly for forward and backward bending as required in many sports. Problems occur for several reasons;

  1. Joint fatigue due to excessive loading. Through repeated repetitive movements or excessive or constant loading.
  2. Joint degeneration. The lower back becomes progressively less mobile with age and in later in life this can cause a progressive diffuse general ache. This is part of a process that is known as lumbar spondylosis, this affects both the vertebra and also the intervertebral discs.

Osteopathy can treat this effectively by using gentle techniques to help release joints and relief muscle tension.

Sacro-iliac joint paint

Typical Symptoms; Lower back, hip and groin pain that can range from sharp shooting pains to stabbing pains that worsen for weight bearing

The pelvis comprises two large bones called ilia and a smaller triangular shaped bone called the sacrum. The sacroiliac (SI) joints are formed by the connection of the sacrum and the iliac bones. While the vertebral joints in the spine are capable of articulating and movement, the sacrum is made up of five vertebrae that are fused together and are unable to move at all. The sacrum and the iliac bones (ileum) are held together by an extensive collection of strong ligaments. These can be damaged and are a potential source of lower back pain and some studies suggest this may account for 20 % of chronic back pain presentations.

There is minimal movement in the SI joints and in fact mobility is limited to about 2 degrees and, unlike the spine, there are no muscles that produce natural physiological movement of the joint. Most of the motion in the area of the pelvis occurs either at the hips or the lower back. The SI joint is designed to be a stress-relieving joint so that it absorbs the forces generated during our gait cycle as we walk. They are essentially required to support the weight of the upper body when we stand. This is a heavy workload and can lead to wearing of the cartilage inside the joint and subsequent degeneration. As with all joints in the body, the SI joints are lined with cartilage that can be damaged or worn away. Over time this will allow bone-on -bone contact as the cartilage degrades and subsequent arthritic development. This is a common issue with SI joints and leading to dysfunction. Typically this can cause pain in the lower back or the back of the hips or in the groin and thighs.

Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released that allow ligaments to relax in the pelvis. This prepares the body for childbirth and this relaxation of the ligaments holding the SI joints together allows for increased motion that can increase stresses and abnormal wear.

Osteopathy can be very helpful for SI joint issues. Pain in the SI joint is often related to either too much motion or not enough motion. An osteopath can teach various stretching or stabilizing exercises that can help reduce the pain or alternatively help mobilize the area to endorse range of movement.

Rib joint pain

Typical Symptoms; Pain between the shoulder blades that is a burning or sharp or stabbing spreading to the front of your chest. Taking a deep breath or coughing/sneezing can make your rib pain worse.

Your rib cage is made up of twelve pairs of ribs. All 12 ribs attach to the spine in the back, and 7 of these continue from the back to attach to the breastbone at the front. For each rib there are two joints in the spine that attach to specific vertebra called either the costotransverse or costovertebral joint. These can be a common cause of pain. Rib joint pain may start suddenly, or develop slowly. Some people wake up in the morning and feel pain just by stretching or twisting “the wrong way”.

A list of symptoms that osteopathy can address with the support of clinical evidence will be shortly available on the home page

Muscle pain in the spine

1, Mid-back (thoracicspine)

Typical Symptoms; Pain on the inside of the shoulder blades that increases with shoulder movements

The most common cause of thoracic mid- back pain  comes from muscular irritation or other associated soft tissue problems. These can arise from overuse injuries that are common in any sport that is unilateral (i.e. from one side) such as all racket. Trauma, a frequent component seen in contact sports, or lifting or throwing based sports are other common issues.

The shoulder blade is integral to shoulder movement involving throwing or lifting. Many of the muscles associated with these movements (such as Rhomboids, Trapezius, Latissmus dorsi) can cause back pain. Many of the other muscles responsible for rotation/movement in the in the neck can also refer pain to the upper back as well. Soft tissue symptoms can also be involved with rib pain or spinal joint pain (refer spinal joint pain) or whiplash injuries.

2, Lower back musculature

Typical Symptoms; Pain that is exacerbated by specific vectors of movement that stretches the affected muscle or muscle group

Soft tissue structures in the spine control movement of the spine. They are also the main tissues surrounding the spinal chord and as such will be involved in traumatic or repetitive injuries. This often evolves from repeated movements such as serving in tennis or a golf swing. Issues that generate constant loading such as cycling or rowing will also affect the lower back anatomy. There are briefly three groups of muscles;

  1. There are a lot of tiny muscles that help connect the vertebra together (intertransverse and interpsinales muscles) that are not responsible for executing movement but do have a big role in proprioreception (sense of joint position). Some of these muscles however, such as multifidus, do also actually help control the vertebra when bending backwards or forwards.
  2. Main muscles in front and the side of lower back are the pscoas muscle and quadratus lumborum. The psoas muscle (joins the lower back to the hip) can cause compression on the lower back when you flex your hip. The quadratus lumborum has an action in side-bending the spine.
  3. Erector spinae. These muscles help anchor the lower back to the pelvis are also commonly involved.

A list of symptoms that osteopathy can address with the support of clinical evidence will be shortly available on the home page

Prolapsed disc injuries

Typical Symptoms; Mild to very acute buttock pain and/or thigh, knee, calf muscle and foot. Pain is apparent as a constant dull ache with and/or tingling.

The correct term for a slipped disc is a prolapsed intervertebral disc (or PIVD). These structures are our shock absorbers but unfortunately they do and can fail us particularly in the age range of 18 to 40 years old.

Intervertebral discs are designed to separate vertebra and give enough space to allow the vertebra to move and bend. They must have the height and thickness necessary in order to achieve this separation.  At the same time they must also be equally pliable without loosing the strength and ability  to sustain compression.

An intervertebral disc comprises a fluid ball bearing in the middle of the disc called the nucleus pulposus. This is like a hydrated gel that is a semi-fluid mass that is capable of expanding when under load. This expansion is in turn resisted by tough circular rings of collagen that encapsulate it. These sheets are tightly packed together like the pages in a telephone directory and are termed as the anulus fibrosus. A PIVD occurs when the semi-fluid mass in the middle of the disc herniates through these tough round rings of collagen. When this material bursts out of the disc this causes extensive inflammation locally and, in particular, causes pressure on the delicate nearby nerve roots. This causes referred pain down the affected limb, possible weakness and pins and needles. In severe rare cases this can also impinge on bowel and bladder function, which is a medical emergency.

The vast majority of disc herniations will occur toward the bottom of the spine. The lower back is termed the lumbar spine and comprises five vertebra with L1 at the top and L5 at the bottom which joins with the pelvis. Most herniations occur at L4-L5 or L5/S1 levels and these nerve roots help form the sciatic nerve. Generally this nerve innervates the muscles in the buttock and back of the leg and ankle and foot. Typically pain is therefore referred into these areas. With careful management symptoms will reduce over time although in severe cases surgery may be necessary.

Our new IDD Therapy programme can help treat trapped nerves, is non-invasive (unlike surgery) and is pain free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.

Sciatic nerve pain

Typical Symptoms; Mild to very acute buttock pain and/or thigh, knee, calf muscle and foot. Pain is apparent as a constant dull ache with and/or tingling.

Sciatic Nerve Impingement occurs at the bottom three vertebra of the lower back (Lumbar 3,4 or 5 vertebra). It occurs because of pressure by nearby parts (typically an intervertebral disc or an osteophyte from a vertebra) The sciatic nerve travels down the back of your leg into foot and provides both feeling and motor power to muscles and skin in this same region; thus pain is felt in this same anatomy when the nerve is impinged. Things to be aware of that are clinically significant.

  • More severe impingement can cause the ankle and foot drop in the ankle to feel weak when walking
  • Progressive leg weakness
  • In extreme cases loss of bowel or bladder control indicates a medical emergency and tingling/ numbness in groin area.

Our new IDD Therapy programme can help treat trapped nerves, is non-invasive (unlike surgery) and is pain free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.

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