Back pain, spinal degeneration and herniated discs

Back pain may seem like a normal part of everyday life for many people, but did you know that if left untreated for a long time, it can become a major problem that affects your quality of life in unexpected ways? 

Back pain can be divided into 2 types: 
1. Muscular back pain
2. Spinal back pain

Back pain from the quadratus lumborum muscle The quadratus lumborum, or QL, hitches the hip, bends the body sideways and arches the back, and also helps stabilise the lumbar spine. If you sit at work or drive for long periods and get lower back pain or a deep ache around the waist, the cause may be an overworked QL muscle that has built up tension. The QL muscle lies in the lower back, attaching to the ribs and spine and to the pelvis, as shown in the picture. 

Habits that make the QL muscle tight and painful: 
Standing with an arched back and the buttocks pushed out (anterior pelvic tilt), which makes the QL work constantly; always standing or sitting leaning to one side, sitting with knees raised, or always sitting with your legs folded to one side, because the QL on that side works on its own. 
Sleeping on your side on a high pillow all night, which keeps the upper side of the waist bent and the QL constantly contracted; when the muscle becomes very tight, it causes pain. Weakness of the gluteus medius, the muscle at the side of the hip that keeps the pelvis level, also forces the QL to help out.

2.1 Herniated disc pressing on a nerve 
This is common in people with back pain radiating down the leg. The lower spine bears a lot of weight and moves more than other parts of the spine, so a disc may bulge out and press on a nerve, causing pain in the lower back and hip that radiates down the leg, usually on one side. There may also be numbness or weakness in the leg or foot. 

Causes of a herniated disc pressing on a nerve 

1. Lifting heavy objects incorrectly 
2. Being overweight 
3. Sitting at work in poor posture and for long periods 
4. Accidents or injuries to the spine 

Symptoms can appear in both the back and the legs. Most people think there is only back pain, but in fact the leg symptoms are more important and more specific to this condition, as they show that the spinal nerves supplying the leg are affected. A herniated disc usually causes sudden symptoms because of severe inflammation. 

• Lower back pain: usually felt in the lower back, on one or both sides. Symptoms mostly occur when sitting or bending forward while seated, the position in which the disc is under the most pressure. 
• Leg numbness: the most prominent leg symptoms come in 3 forms: pain, numbness or muscle weakness.

2.2 Spinal degeneration (spondylosis) 
This is when the vertebrae, discs, joints, ligaments and back muscles degenerate, making the spine less flexible and stiffer. It most often affects the neck and lower back. Spinal degeneration is caused by wear and tear with age and is generally seen in people aged 40 and over, but it is increasingly found in younger people who put heavy strain on their bodies over long periods, causing the spine and discs to degenerate. This makes the joints stiff and inflexible and may compress nerves. If your ability to move becomes abnormal or you have problems such as numbness and weakness in the hands, arms, feet or legs, see a doctor promptly for treatment and to help prevent further degeneration.

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1. Focused shockwave therapy

Delivers energy through shockwaves to the injured area to reduce inflammation and pain, while also stimulating the body's repair process and treating chronic pain.

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2. High-power laser therapy

Helps energise cells and stimulates the body's repair process, rapidly reducing inflammation. It also helps reduce nerve-ending irritation such as numbness and burning.

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3. Therapeutic ultrasound (deep heat)

Helps treat injuries to tendons and soft tissue and speeds up the repair process by increasing blood flow and the flexibility of connective tissue, while reducing pain and muscle tension.

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4. Lumbar traction

Relaxes the muscles of the neck or back. The traction force is calculated according to body weight, and the pull and release times are set appropriately for safety and more effective treatment.

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5. Electrical stimulation (TENS)

Transcutaneous electrical nerve stimulation that helps reduce pain.

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6. Therapeutic exercise and hydrotherapy

To correct posture and restore strength so that the pain does not come back.

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1. Dry needling

Relieves pain and releases tight spots in the muscle known as myofascial trigger points, using a fine needle to make the trigger point relax.

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2. Injections (prolotherapy)

A concentrated solution such as glucose is injected into the injured or inflamed muscle area to stimulate repair and accelerate the body's natural healing and recovery. Ultrasound is used to guide the injection so that it reaches the exact problem spot accurately, reducing the risk of hitting a nerve.