The following is an overview of a common condition that is a frequent cause of low back and leg pain, along with details of some of the current forms of treatment which may help to relieve the pain and discomfort associated with it.
It’s morning, the alarm clock has just gone off, and you look up from your bed to see it’s still dark. The rain and wind are clattering against the window, and it is taking all your might to pull the duvet off to get out of bed. And it’s made all the more worse knowing that for the next 10-15 minutes, you’re going to be shuffling around until the stiffness and pain in your back eases. ‘Wear and tear’ they call it… I thought life was meant to begin at 40, yet they say my spine is degenerating!
It is a well-known fact that the joints and tissues in our bodies are susceptible to the physical wear and tear of everyday life. This natural, degenerative process affects us all and tends to be more prevalent the older we get. It most commonly affects the weight bearing joints, including the hips, knees and spine. When degenerative changes occur specifically in the vertebrae and discs of the spine, the condition is known as Spondylosis. When degenerative changes occur in the facet joints of the spine, the condition is known as Spondyloarthrosis.
These two conditions often occur together and the cause is most commonly an effect of the ageing process, where degeneration builds up gradually over time. However, it is likely that these conditions develop due to a number of different reasons, including occupational, postural, traumatic, and environmental factors. Other risk factors for developing these conditions include obesity, bone developmental abnormalities and other joint diseases such as Gout, as well as others. It is possible for these conditions to present as early as 20 years of age, but this is rare and is usually as a result of a previous trauma to the affected area. It is more likely to affect people from the age of 30 years onwards, with a very high prevalence in those aged 70 years or above. Males and females are both equally affected with these conditions.
The most commonly affected areas in the lumbar spine include the L4-5 and L5-S1 segments. As the condition develops, a person will start to feel increasing amounts of pain and stiffness in the low back. Stiffness is usually experienced following long periods of rest, for example, in the mornings after waking up or standing up from being sat down in a chair. Generally, the stiffness will ease within 10-15 minutes of movement, but this varies from person to person.
As the degeneration worsens, a person may feel the effects of spinal stenosis, which is narrowing of the spaces which the spinal cord and nerve roots run through and out of the vertebrae, respectively. Narrowing of the spaces is usually caused by any combination of the development of bony outgrowths called osteophytes, intervertebral disc prolapse and thickening of the surrounding spinal ligaments. These can lead to impingement of nerve fibres causing sciatica type symptoms. This type of pain is known as radicular pain.
These conditions can be treated using a variety of methods. Manual therapy may include spinal and limb joint mobilisations, manipulations and tractions, as well as the release of soft tissue structures including muscles and fascia. Exercise to strengthen the surrounding muscles and to aid in maintaining flexibility and range of motion in the joints is extremely important and requires full commitment from the patient to ensure the best outcome. Your GP may prescribe a course of painkillers, anti-inflammatories or muscle relaxants to aid during periods of more intense pain or discomfort. There are also various pain relieving injections available if necessary. These may be injected into a facet joint or in the form of an epidural injection to act on the affected nerve tissue directly. Unfortunately some severe cases may require decompressive surgery, but this is usually a last resort, and will only be considered in instances where manual and drug therapies are no longer beneficial. Ultimately, it is important that each patient is educated accordingly so that they can take steps to reduce the harmful aspects of their lifestyle, which could be contributing to their condition. Losing weight, being more aware and correcting a poor desk-based working posture and increasing exercise are just a few changes that will go a long way to slow the progression of these conditions and improve long term outcomes.