Spine Symptoms

Back Pain

Back symptoms are very common, and is the biggest cause of time off work. Most people will at some time or other develop one or more episodes of significant back pain. Back pain is normally due to what is classified as 'mechanical back pain'. What this means is that the pain is coming from the muscles, ligaments or joints in the back, normally due to a strain.

Mechanical back pain can be caused by poor posture, from sudden movements (eg a whiplash injury) or from lifting something too heavy or turning too suddenly.

In the past, the advice that was given to people with significant back pain was to rest in bed for a prolonged period. It is now understood that this advice was wrong, and that the best thing is to rest for the shortest period necessary, and to then get going and exercise as soon as possible, as this actually quickens recovery.

Most episode of back pain settle within just a few weeks at most. During there are many different painkillers available that can reduce the pain and make things more bearable. Also, it has been shown that early courses of physiotherapy treatments can speed recovery, strengthen the muscles, improve posture and reduce the likelihood or frequency of further episodes in the future.

Leg symptoms

Back pain can often 'radiate' into the legs. This is where pain arising from a muscle, ligament or joint in the back is felt to pass from the back and down into the leg. However, sometimes there can be a slipped disc / disc prolapse in the back. In between the vertebral bones (vertebrae) of the spine, there are ovoid discs with a jelly like centre and a fibrous outer capsule. These discs act as shock absorbers between the vertebrae. As we get older, these discs tend to dry out and become degenerate. As the weight of the body pushes down on the vertebrae, discs can get squeezed outwards. If they protrude backwards, towards the spinal canal, then the prolapsed discs can press on the spinal cord or the nerves that pass outwards from the spinal cord.

Alternatively, it is possible to tear the outer fibrous capsule of the intervertebral discs. This can happen, for example, from heavy lifting or sudden twisting. The inner jelly like disc material can then prolapse outwards, and this can press on the nerves in the back causing symptoms.

The most common nerves that cause problems in the back are those that form the sciatic nerve. The sciatic nerve passes from the spine, through the buttock and then down the back of the leg to the foot. Therefore, anything causing pressure on these nerves causes 'sciatica' - where you get pain shooting down the back of the leg to the foot. There may also be pins and needles or even numbness. In severe cases the nerves to the muscles can be affected, causing weakness in the leg/foot.

In cases where patients have severe pain or significant nerve symptoms in the leg/foot and where symptoms fail to settle, it is normally appropriate to get an MRI scan of the spine to see exactly what might be causing the symptoms.

The red flags

When a patient with back pain goes to see a doctor, the doctor normally checks that they haven't got one or more of the so-called 'red flags' - these are symptoms that may alert the doctor to the possibility of something more significant underlying a patient's back symptoms.

The generally accepted 'red flags' include:-

back pain that persists severely for more than 6 weeks
back pain that is present constantly, at rest and at night in bed
back pain where the pain is unusually severe
back pain with significant neurological signs
abnormal gait (the way you walk)
associated bladder or bowel symptoms
thoracic back pain (pain in the upper back, at the back of the chest)
where the patient also has other more general symptoms, such as general malaise, fever, weight loss or abdominal symptoms
past history of cancer
age < 20 years or > 55 years

If you do have any of these symptoms, then please try not to be too alarmed, as most episodes of back pain are still due to simple mechanical back problems, even if one or more of the 'red flags' are positive. However, if you do have 'red flags' then it is advisable to see your doctor so that you can be checked out properly.