Conditions

Introduction

Back pain is extremely common and most people will suffer from it. The pain comes in two forms: acute and chronic. Acute pain comes suddenly and intensively. It is caused by mechanical disorder of one of the structure in or around the spine; from wrong way doing, physical activity (sprain, strain to muscles or ligaments or the joints between adjacent vertebrae), accident or hereditary caused. Other form of back pain is chronic. If the acute conditions are not being taken care of then they can also become chronic by recurrence. There are non-specific back pains and specific such as:

• osteoarthritis,
• disc involvement (prolapsed - called slipped disc, herniated disc - causing sciatica,)
• spondylolisthesis (causing sciatica)
• scoliosis
• coccydynia
• ankylosing spondyllitis
• Paget’s disease
• osteoporosis
• cancer in the spine
• gynaecological cause
• kidneys disorders
• abdominal problem (peptic ulcer)
• pancreolitis (inflammation of the pancreas)
• aortic aneurysm (localised widening of aorta)

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Examinations

X-ray of spine – will show up conditions such as osteoarthritis and osteoporosis.
But will not show ligaments, muscles, and damage to vertebral joints or disc.

MRI (magnetic resonance imaging) – this uses magnetic fields and radio waves to built up an image of the spine

Scan – investigation by screen images, divided from high frequency sound wave.

X-ray, MRI, CT - show some irregularity in bone or tissue structure which assist to in proper diagnosis but have very little clinical value, when back pain are due to basic mechanical causes.

Myelography or Discography are tests which will show prolapsed disc or degenerative joints (but can cause side effect).

Radiomuclide scanning (radiation emitter) this is an investigation for a cancer.

Blood tests may detect inflammatory joint diseases or infections.

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Treatments and other options.

Successful treatment of spine will depend on accurate diagnosis, which requires a clinical knowledge and understanding (pathology, patient case, history and other factors) that can only be gained after many years of practising and extra study. There are many therapists who claim that they can treat back pain but that not always is the case. There are indications and contraindications how to treat difficult cases (disc prolapsed causing sciatica) and wrong treatment can often make condition worse, do some damage and delay the healing). The most commonly known therapies for the low back pain are:

• physiotherapy
• osteopathy
• chiropractic
• Alexander techniques
• acupuncture (see index)
• Painkiller - NSAIDs or muscle relaxants may bring the relief; but will not solve the problem.
• Epidural injection - is only to anaesthetise nerves for short period and
• Cortisone (which is very toxic} anti-inflammatory injection does not treat the causes,
• Chemonucleotysis - special injection of enzyme (catalyst) into the centre of prolapsed disc to shrink it and so reduce pressure on surrounding ligaments or nerve roots (not successful and dangerous).
• TENS (transcutaneous electrical nerve stimulation) is helping to reduce the pain, message being transmitted to brain. It does not resolve the underlying condition. Very often is used after unsuccessful back surgery to suppress the pain.
• Spinal surgery - this is a last resort especially when spine has suffered a very traumatic life threatening injury. Very often it is not suitable for many conditions. It may serve to free a trap nerve root but the record of failures is very high. Postoperative scar tissue grows and presses on the nerves in the intervertebral spaces. The tethering of nerve roots may cause numbness, burning or tingling in different part of the body, depending on the nerve effected.
• Ancient Greek’s medical philosophy “if you can’t help do not make worse”.

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How to avoid back pain

• maintain correct weight
• exercises for back and abdominal muscles (carried out while lying down)
• wear comfortable flat or low heel shoes (soft and well padded if long walk)
• firm sleeping mattress
• correct lifting by squat dawn in knee-bend and keeping back upright.
• always slow getting from forward bending to upright position.
• stretching and worming-up before any physical activity (sports).
• posture (correct way to sit and stand)
• swimming is the best sport, which can help reduce or prevent back pain (A and B-crawl).
  

PLEASE NOTE; This suggestion may help or prevent back problem but we will provide each patient with individual indications and exercises, which will depend on the case.

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Back Injuries

Slipped disc
Disc is a piece of the cartilage (jelly-disc) that acts as a shock absorbent and separates the bones. The disc bulges backwards causing pressure and pain (when the pain radiates down a leg is called sciatica)
Treatment: see our Techniques for details

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Sciatica (pain down a leg)
The pressure on the nerve root (sciatic nerve) is caused by the spongy nucleus of the disc. The sciatica could also result from a vertebrae slipping forwards of over the spondylolisthesis (the one below ). The pain from the sciatic nerve could be in buttock, tight or leg.
Treatment: see our Techniques for details.

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Disc prolapsed/herniated
Very serious but common problem that needs special care and treatment. It may happen when the back is put under great strain, for instance by the wrong way of lifting heavy load or a sudden awkward movement. This may cause the cartilage (part of disc) to squeeze out of place and press the nerve. It results in severe shooting pain in lower back and the legs, often numbness or tingling (injury of lower back may affect bladder or bowels).
Treatment: The safest methods to treat these cases are Maitland mobilisation techniques (for details see our Techniques).

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Ankylosing spondylitis
This is inflammation of the spinal joints that causes back pain, stiffness and subsequently lost of mobility (rest will not help, it can make it worse).
Treatment: We can treat this condition very successfully by using special mobilisation techniques (see our Techniques). The patients are given individual program of exercises that are not difficult, very effective and do not require much time. Usually after six to ten sessions patients can start their individual program of exercises to prevent the stiffening process of spine.

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Sport injuries

The main goals of treatment and prevention of sports injury are:

• reduce the symptoms ,
• restore and upgrade the and flexibility
• decrease the risk of injury and recurance
• increase performance
  

Frozen shoulder
This is stiff and painful shoulder joint (capsulitis) usually followed by minor injury. The pain comes a week after and increases over 4 months .The joint becomes progressively stiff and more painful then the pain eases but the shoulder remains stiff. The untreated shoulder will not regain full range of movements.
Treatment: Special mobilisation techniques of the joint and connective tissue supplemented by ultra-sound or laser must be applied. Once the pain and stiffness is reduced the patient will have to do special exercises, which will restore full function of the joint.

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Arthritis
This is inflammation of a joint as a result of trauma, injury or can be athritic process throughout the body. The joint is swollen painful and movements are limited.
Treatment: Treatment - mobilisation of the joint and connective tissue supplemented by interferential, laser or ultra-sound will increase the circulation, which help to reduce the swelling, increase the range of the movement and reduce the pain .The treatment had to be follow by individual exercises to restore the function of the joint.

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Ankle sprained
The degree of the damage tissue of the joint varies with individuals so does the recovery. The fluid of the joint leaks from the torn fibres and causes localised
Treatment: It is best to immobilise the joint and stop the sports activity. Cold compress (ice cubes) should be applied as soon as possible. Within 48 hours the physiotherapy treatment should be start. Interferential current and ultra-sound is the best. After few days gentle mobilisation technique have to be administered. Bad cases may take up to 6 weeks before the gentle training can start. The right timing for return to sports activity or running is extremely important, and must be done by stages so the condition will not reoccur and lead to another injury.

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Whiplash (see also Neck pain)
When the car is hit behind by another car or stops suddenly, the head of the driver or the passengers move forward and goes backwards. These uncontrolled movements put strain on the joints of the neck together with the ligaments, skeleton muscle and connective tissue. After few days the neck become inflamed, stiff and painful.
Treatment:
1st stage: the neck has to be immobilised (collar support).
2nd stage: after few days the mobilisation technique can be applied with ultra-sound or laser.
The treatment must be continued till the symptoms disappear. Very often there is some radiation of pain to one or both arms, that whiplash must be handled with extra care with priority to reduce the compression of the nerve.
Whiplash injury must be treated otherwise there could be formation of trauma tissue around the joints and that could create more complication in the future.

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Tennis or golf elbow (epicondilitis)
The problem is not always related to tennis or golf players and could be caused by other activity or exercises. It is inflammation of forearm muscles tendon that produces the pain and the patient is unable proper gripping, lifting etc (we do not recommend injections).
Treatment: Stop the exercises or activity, which activate the pain. Start the treatment as soon as possible. Laser or interferential, follow by friction or connective tissue manipulation will reduce the symptoms. After that special exercises will prevent recurred of the condition.

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Supra-spinatus Tendinitis
It is muscular pain on the outside of the shoulder. It creates difficulty in lifting the arm out to the side and return. Inflamed tendon does not recover by itself and by force activity could be damage.
Treatment: Sooner treatment - faster recovery. Ultra-sound and interferential will reduce the inflammation and pain after that friction of the tendon and special mobilisation technique will restore movement.

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Tendon Injury
The tendon (origin and insertion) connects the muscle to the bone. The cells of the tendon have very minimal blood supply therefore the damage heals very slow (full rapture needs surgery).
Treatment: Activity or movement must be minimised not to aggravate the problem. Laser, interferential or ultra-sound will be applied depends of the area and degree of the injury. After few days mobilisation and friction to the inflamed tendon can start then gentle exercise. The recovery will depend on many factors.

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Calf Muscle Torn
Caused by activity, sprint or dash without warming-up; in the case of a full rapture the surgery may be needed.
Treatment (stages):
1. Cold compress to stop swelling
2. After 24 hours physiotherapy treatment (ultra-sound or interferential)
2. Laser and friction of muscle fibre
3. Gentle mobilisation technique and connective tissue massage
4. Special exercise to activate damaged muscle
5. First activity or exercise
6. Return by stages to full training

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Shine Splints
Pain on the front of the shin that is caused be tension and inflammation of connecting tissue of the muscles. Pain in the front of the shin, which could be constant or occur only during and after exercises.The exercise and training should be stopped (forceful exercise could cause stressed fracture of the shinbone)
Treatment: Ultra-sound and interferential to start with, then connective tissue mobilisation at later stage. The right timing is very important for the full return to sports and exercises.

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RSI – Repetitive Strain Injury
When the same group of muscles are used excessively (repetitive manual work, keyboard operators, typists) they become painful, swells and week. There could be some numbness, tingling (hands, fingers) redness, tenderness and etc. Carpal tunnel syndrome is one of the most common injuries, which effects the wrist joint.
Treatment: Rest from causing activity, physiotherapy in right time can prevent surgery, that very often is not successful and clear the symptoms only for few years.

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Muscle pain
The are three types of muscles in our body:
*Smooth (involuntary or visceral) for lining the blood vessels and some internal organs
* Cardiac (forming heart)
* Skeletal (voluntary) forming the main muscle of the body and responsible for voluntary movement

Muscle pain (myalgea) it is pain in the skeletal muscle. The muscle depends on a good blood supply that provides adequate oxygen and glucose to remove waste products. The interference with this process will lead to pain.

Typical muscle pain is from:

• over exercise, lack of oxygen brings by product (lactic acid) which high level causes fatigue, cramp and pain
• trauma (injury) is common cause of muscle pain
• muscle spasm and involuntary contraction due to injury, strain or pressure on nerve
• infections (influenza) effect the muscle and cause pain and spasm
• cramps (at night) mostly in bed, they are common in elderly
• intermittent claudication – due to impaired blood supply to the muscles usually from arterial diseases
• polymyalgia rheumatica (unknown cause) it is muscle stiffness and aches around the shoulders
  
  Treatment: Many of this cases can be treated by physiotherapy methods and will have good result without side effect (massage, interferential, ultra-sound and mobilisation techniques) otherwise they can be treated by painkillers or anti-inflammatory drugs but some will have side effect if use for long time.

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Myalgea – see Muscle Pain

Rheumatoid Arthritis (inflammatory disease of the joint lining)
The exact cause remains partly unknown but in the last few years the scientist are coming closer to identifying some types of RA (hereditary) were the genes are passing the disease in the family from generation to generation. We also know that the immune system instead protecting the body from the disease attacks the joints causing inflammation. The diagnosis of the RA is based on blood test. RA has got different stages. First it flares up then goes into remission for weeks, months or years, then comes back in mild form or very strong causing severe pain and deformity of the joints.

Treatment:

• physiotherapy: ultra-sound, laser, interferential, gentle massage with special ointment and regular exercises of the joints and muscle strength
• diet ; to control the weight and health (celery seed tablets, parsley tea)
• homeopathic remedies (arnica, bryonia alba or pulsatilla)
• anti-inflammatory drugs and painkillers (common procedure)
• the surgery – the joint may have to be replaced by prosthesis (artificial joint) but it is a long operation with enormous impact on the general health (very often not successful)

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Neck pain
There are seven cervical vertebrae supported by ligaments, muscles, tendons and other fibre. It is very verneable section of the spine because the spinal cord (brain extension) caries nerve impulses between the brain and the rest of the nervous system.

The most common problems with neck

• wry neck; minor injury which produces muscular spasm. The neck fills tight twisted and head goes to the side. This can happen overnight (bad sleeping position), sudden turning of head or sitting in awkward position.
• over–exertion: incorrect or excessive exercises can pull muscles (overstretched and tear) which become swollen, tight and tender to touch.
• cervical osteoarthritis: progressive degeneration of neck joints (often as consequence of ageing) restricts the movement (stiff neck), tingling sensations in arms and hands are caused by bony outgrowths formed on cervical vertebrae.
• prolapsed disc (slipped disc); deformed disc presses against adjacent nerves. Symptoms: aching and twisted neck, numbness, tingling, weakness in arms or hands.
• partial dislocation of vertebrae; will cause pain and spasm in muscles. The ligaments and disc may also be damaged causing pain and numbness.
• Ankylosing spodylitis; inflammatory disease effecting the joints between the vertebrae. Not treated will damage joints and fuse them which brings permanent neck rigidity and pain.
• neck injury (see under Whiplash)
• neck injury (fracture one or more vertebrae with or without dislocation) which is life threatening condition and may cause paralysis if not properly attend or immobilised.
  
  Treatment: Most of the cases could be very successfully treated by special mobilisation or manipulation techniques. (see our Techniques for details)

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Spine Facet Joints
They are small joints that link the vertebrae together. By twisting (e.g. while playing golf) or bending and twisting them one or few could be pushed out of the place.
The symptoms are pain in upper or lower back , that also can go to chest, hips, tights or buttocks; if neck is twisted the pain will travel to shoulders or upper arms
Treatment: Force movement in that part of spine will aggravate the pain. The muscle and tissue over the facets joints are tender with some spasm. We have treated hundreds of the cases with over 90% recovery and to the rest we brought relief. By using mobilisation techniques (Maintland) and finalising with manipulation (if not contraindication) we clarified the symptoms.

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Knee injuries – most common.

Sprained Ligament (snapped or torn - very rare)
The symptoms are swelling, pain, stiffness, tenderness.


Torn Cartilage
Badly torn cartilage or snapped ligament caused instability of knee.
Two like half-moon meniscuses are protective pads of cartilage between thigh and shine bone are like suspension for the joint. If the knee is suddenly wrenched while the foot is still on the ground one of the pads may be displaced or torn and the knee may be lock. Sudden fall or making at another body or object could also cause that injury. The symptoms are severe pain, tenderness, instability, lost of movement, clicking, swelling.


Dislocation
It can be caused by a violent blow and the symptoms are like previous with deformed look of the joint.


Fracture of the knee cap (patella)
It is usually caused by direct blow. The symptoms are: severe pain at the front of kneecap, inability to bend, swelling and bruising

Treatment:
First Aid Procedure:
1. Comfort injured person
2. Apply an ice pack for 10-15 minutes to reduce the swelling (when sprain)
3. Good support (after 10 minutes check if blood circulation is not restricted).
rest for 48 hours

Thereafter:
When walking - stick may be necessary to take of the weight.
When dislocation - support the knee but not force it.
Damaged cartilage could be seen by instrument called an orthroscope (viewing tube).
If the surgery is necessary the procedure is called arthroscopic meniscectomy which involves trimming damaged meniscus (takes 30-60 minutes).
After 48 hours of the injury physiotherapy treatment should be apply to accelerate heeling process by repairing damage tissue, restoring full movement of the joint and muscles strength. After long period of immobilisation (fracture, damaged ligament), special mobilisation techniques of the joints and connective tissue is applied, combined with ultra-sound, interferential therapy or laser to repair damaged ligament, tendon or muscles.
The progress must be monitored before patient goes back to exercises, running or other sports. Preparatory exercises or training must be introduced for one who is involved with sports like football, rugby, ski or running. Only experience therapist can control this and do right timing for full training so the symptoms will not recurred.

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