Working Out Why Your Back Hurts

So many of us are blighted by back pain, interfering with our lives, be it sports, work and recreation. The numbers are astounding: 85% of the population will have time off work because of back pain, and in the UK around 11 million of us are suffering right now.

Many factors contribute to this, these include posture, occupational activities, weight and overall fitness etc. However, once it has started, it needs to be dealt with quickly to prevent the person becoming a chronic pain patient. Dealing with any medical problem starts with a diagnosis, and this is where most back pain management falls down. Labels such as "mechanical back pain" and "muscle spasm" are not diagnoses.

The best way of diagnosing the problem, after taking a clinical history and examining the patient, is for the doctor to arrange an MRI scan. This involves lying in a tubular scanner for around 20 minutes (upright open scanners are also an option) and shows all the 'soft tissues' in the area being examined. In the spine these include the discs, joint linings, muscles and the nerves. Treatment options can then be decided upon, which include:

1. Physiotherapy

2. A back brace

3. Spinal injections

4. Surgery

Of patients with severe pain, less than 5% need surgical treatment. So having a diagnosis does not mean that the patient will have an operation. In fact, just the opposite is true, as it will allow targeted treatment to be instituted for the problem. This should prevent further problems down the line.

The image below is an MRI scan of a gentleman (70 years of age), who had suffered back pain for 20 years, which had started to affect his walking. He had to stop and rest every 20-30 metres.

L2/3 disc is normal

L3/4 disc bulge- because the bone above has slipped forwards a little and the white fluid space for the nerves behind is narrowed.

L4/5 disc has collapsed over the years, with bone spurs at the front and bulging at the back again narrowing the space for the nerves.

The L5/S1 disc is also collapsed, with bone growing across it at the front

Mr John Sutcliffe -

Triage Consultant Spinal Neurosurgeon 

Lead Clinician London Spine Clinic

MBChB FRCS(Ed) FRCS (SN)