The Lumbar Spine is an intricate structure of bones (5 vertebrae, numbered L1 - L5) the sacrum, coccyx, muscles, ligaments, tendons and a highly sensitive nerve and vascular supply.
Even though incidents of lumbago and sciatica are recorded as far back as Hippocrates, for the majority of patients the true cause of lower back pain remains a mystery. Such ambiguity is a direct reflection of the complex anatomy of the spine, where there are many pain producing soft tissues, including the articular joints, corresponding nerves, ligaments and muscles. Despite this complexity, lower back pain can be divided into several recognised categories:
- Lower Back Muscular Sprain/Strain
- Facet (Zygapophysial) Joint Pain (Dysfunction)
- Spinal Stenosis
- Slipped (Prolapse) Disc
- Sacroiliac Dysfunction Back pain can be caused by: Lifting, pushing and pulling incorrectly, sitting for long periods (e.g. driving), improper sitting (slouching), repetitive movements, overuse in sports, bending incorrectly, trauma, wear and tear of joints (osteoarthritis).
Sometimes back pain can occur without any apparent mechanism of injury
Symptoms of lower back pain
Depending on the cause and structure involved, there can be many different symptoms for lower back pain:
- Pain and stiffness in the back
- Referred pain in the buttocks and the legs
- Pain that worsens when bending, stretching, coughing, or sneezing
- Tingling, weakness or numbness that radiates from the lower back and into the buttocks and legs – especially with activity
- Activities such as walking, twisting and bending may increase the pain
- Other symptoms include a ‘pins and needles’ sensation, or tingling and difficulty moving or controlling the leg
- Typically, symptoms only manifest on one side of the body.
There are many different conditions that can cause back pain, so a thorough medical history is performed as part of the examination. Important questions are asked to ascertain the source of the pain, and then a physical examination will be performed.
Additional diagnostic tests for lower back pain include:
X-ray – Provides information on the bones in the spine; used to test for spinal instability, tumors and fractures.
MRI scan – Displays a detailed cross-section of the components of the spine.
Paracetamol is effective in treating most cases of back pain. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.
If muscle spasms are present, a short course of a muscle relaxant, such as diazepam, can be taken. Some people find that non-sterodial anti-inflammatory drugs (NSAIDS), such as ibuprofen, are more effective.
Physical therapy such as physiotherapy, osteopathy and chiropractic treatment can help with back pain. These treatments involve exercises, posture advice, massage and techniques known as spinal mobilisation and spinal manipulation.
Injections for lower back pain
Injections can help to deliver medicines (local anaesthetic and anti-inflammatories) directly to the source of pain, so it is possible to progress with physiotherapy or other rehabilitation.
There are four injection techniques available for lower back pain:
- Caudal Epidural Injection. This targets the space that surrounds the spinal cord.
- Sacroiliac Joint Injection. These injections target the sacroiliac joint
- Facet (Zygapophysial) Joint Injection. These target the joints that link the bones of your spine.
- Nerve Root Block Injection (also known as Pararadicular Injection). This targets individual nerves in the spine.All injections are performed using Ultrasound Imaging.
Advantages of Ultrasound Injection versus Fluoroscopy:
- No exposure to Ionizing Radiation
- Real-time needle guidance
- Direct visualization of the target of interest
- Shortens procedure time
The old proverb is true; “Prevention is better than cure”. And this philosophy is never more apt than when applying it to your own personal health.
The Health Promotion & Preventive Medicine service aims to promote and maintain good health and well-being, prevent disease and reduce the chance of disability. This service combines public health skills with knowledge of primary, secondary and tertiary care prevention strategies.
Disease prevention involves specific interventions aimed at avoiding contact with the disease and decreasing risk factors for disease. Where this is not possible, we use treatments to minimise any harmful consequences of the disease process.
Health screening is a major component of this service and involves routine testing to see if you are at risk of developing future health problems.
Knowledge is power, and thus our goal is to educate patients about their own health. We try to clearly communicate accurate, useful, health-related information to patients. Empowering patients in this way is crucial to help them make the right health choices and improve their overall wellbeing.
We focus on six main areas of disease:
- Cardiovascular Diseases (heart attacks and stroke etc.)
- Respiratory Diseases (e.g. chronic obstructed pulmonary)
- Obesity and Weight Management
- Mental Health
A major determinant of your wellbeing is the amount of knowledge you have about health issues, but also your attitude and desire to bring about positive change in your life.
Compartment Pressure Testing is the ‘Gold Standard’ for diagnosing Chronic Exertional Compartment Syndrome [CECS].
The test involves inserting a small catheter, under local anaesthetic, into one of the four well-recognized compartments of the lower leg. (Anterior, Lateral, Deep Posterior and Superficial Posterior) When the catheter is in place, the patient is then asked to run until they experience the pain. The pressure is then again measured post exercise.
The key benefit of Compartment Pressure Testing is the role it plays in diagnosing Chronic Extertional Compartment Syndrome (CECS), which makes it a vitally useful tool for athletes and runners.
Chronic Extertional Compartment Syndrome
Chronic Exertional Compartment Syndrome is a condition that can be caused by exercise. Repetitive movements, such as running, can induce high pressure within a closed space, which results in decrease tissue perfusion. This causes symptoms such as pain, cramping, burning, tightness and weakness of the effected lower limb.
There are four key factors believed to contribute to an increase in compartment pressure:
- Inelasticity of the fascial sheath
- Increase in volume of skeletal muscle secondary to blood volume and oedema
- Muscle hypertrophy (enlargement) in response to exercise
- Dynamic contraction factors due to demands in the gait cycle.
Compartment Pressure Testing is an incredibly useful diagnostic tool to exclude other causes of exercise-induced leg pain such as stress fractures, periostitis (inflammation of band of tissues that surround bones), Medial Tibial Stress Syndrome various tendinopathies, neurological compression syndromes and infection.
When the catheter is in place, the patient is then asked to run until they experience the pain.
The pressure is then again measured post exercise.
Lipogems is a game changing regenerative medicine therapy that can be used to treat a wide range of orthopaedic conditions.
And it couldn’t be simpler. The entire process is carried out in just one surgical step. Fat tissue is taken from your own body and transformed into an injectable substance that has unique and remarkable healing properties.
The Lipogems method is incredibly safe. The fat tissue we extract is immersed in a saline solution, which means we minimize any trauma to the cells. In addition, residues that promote inflammation are removed from the cells to help ensure quick and easy recovery. The procedure is minimally invasive and transplanting your own cells eliminates the risk of rejection.
Your fat tissue contains a high volume of MSC (Medicinal Signaling Cells), and when activated after local injury, establish a regenerative microenvironment by secreting bioactive molecules which regulates the local immune response, and in addition supports and encourages your body to heal.
The procedure itself only takes around 90 minutes. The area of fat tissue is injected with anesthetic and saline, and then the tissue is extracted. The fat is then subjected to the Lipogems process – which takes around 20 minutes – to turn it into an injectable substance. This substance is then administered into the areas that requires healing.
The LIPOGEMS technique which has been used in more than 8000 cases worldwide and is performed by Dr Ralph Rogers on site at 108 Harley Street. It issuitable for patients:
- Who want relief from pain and/or improvement in function
- Who suffer from an injury that limits normal daily functioning or physical activity
- Who have had other treatment options which have not provided relief
- Who wish to explore it as an alternative to major surgery
What is PRP?
Platelet rich plasma is an innovative treatment in sports and orthopaedic medicine, PRP uses your own blood for healing muscle, tendon and ligament injuries.
To perform this treatment we place a small amount of your blood in a filtration system, which separates your red blood cells from the platelets. The high concentration of platelets is then injected into your injured tissue, which initiates your body’s natural healing response.
After the treatment you’ll be given a prescription for pain medication for overnight use. Non-steroidal anti-flammatory medication (such as Ibuprofen and Neurofen) should not be used after treatment. However, cold therapy and icing of the affected area may be used. Following treatment, a stretching and strengthening exercise program will be prescribed, as thorough rehab is vital for a rapid recovery.
Benefits of PRP
PRP is the perfect treatment for those suffering from damage to your muscles, tendons or ligaments. The body’s own ability to heal these sorts of injuries is relatively poor and often leads to scarring, which not only affects the function but also increases the risk of further damage.
PRP gives the body a helping hand by mimicking your body’s inherent desire to heal itself. It couldn’t be simpler. Following the series of injections and strengthening exercise program, you could see a huge improvement in your injury and a significant reduction of pain.