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Lower back pain is incredibly common, and is the leading cause of disability globally. While painful, symptoms are seldom anything to be concerned about and in fact the prognosis for recovery is good - typically 8-12 weeks. 

For some, people with lower back pain report symptoms that can be felt into the leg. More often than not, people who experience such symptoms have either been told or report that they have 'sciatica'.  However, over the years sciatica has been used as an umbrella terminology to describe ANY pain felt in the leg when actually there are several reasons this may occur, two of these causes are:

1. Neuropathic Pain: Defined as 'pain caused by a lesion or a disease of the somatosensory nervous system'. In other words, back pain associated with a disc herniation, which causes compression of the nerve leading to symptoms down into the leg
2. Nociceptive Pain: Defined as '  pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. Nociceptors are triggered by mechanical, chemical, or thermal stimuli arising from all innervated structures’. In other words, pain that arises from another structure around the lower back but not associated with nerves.

It's important to attempt to identify whether the pain is associated with the nerve of another structure as ultimately the treatment moving forward will vary. So, are there different symptoms that people experience that could help differentiate between neuropathic (nerve) and noiceiptive (other structure) pain? Fourre et al have identified common signs and symptoms which can help (see below)

Chronic lower back pain (CLBP), which is classed as persistent pain that continues for greater than 3 months,  is prevalent in 3–4% of adults below 45 years of age and  5–7% of adults over 45 years of age. While a large majority of lower back pain It can have a significant impact on quality of life, function and ability to participate in work and activities, leading to numerous investigations and various referrals to other healthcare professionals. 

These two studies attempted to examine movement patterns in people with and without lower back pain, as well as how changing thought patterns around their beliefs can help their pain and function.

Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting techniqueis associated with LBP (Saraceni et al 2021)

People with chronic lower back pain usually report difficulty in bending forward, in particular when attempting to lift anything heavy. This study attempted to review biomechanical movement pattern differences in manual labourers with and without chronic lower back pain (>5 years).

What they identified was that those with lower back pain used a different lifting technique when compared to those without lower back pain. Those with back pain performed more of a slower, 'squat' type lift, with a greater knee bend and straighter lumbar and thoracic spine as well as greater peak knee forces when standing. Those without lower back pain performed the lifting task with a quicker, more stooped like posture with less knee bend.

Their conclusion was that the common assumptions around lower back pain associated with movements and the forces produced during a lifting task were not observed and brings into question the current belief around safe lifting.

From protection to non-protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain (Wernli et al, 2021)

This mixed method study design examined the benefit of Cognitive Functional Therapy (CFT) in people with chronic lower back pain (CLBP). 12 people were interview at the start of the study, identifying their beliefs about their back and the 3 movements and postures that they find most provoking. A course of CFT was delivered over a period of 12 weeks, where participants were interviewed afterwards to review their movements and their perceptions of their symptoms.

At the end of the 12 weeks, 11/12 people had reported significant improvements in their pain and function, enabling them to return to their usual activities and in some instances (7/12 people) not think about their back pain at all. The authors of this study identified two groups for both before and after the intervention which I believe is extremely useful:

Before Intervention

1. Non-Conscious Protection - A lived experience of being stiff, restricted, tense, locked or seized up 
2. Conscious Protection - Tense, guarded, careful and cautious movements and postures due to belief of structural damage / vulnerability, fear and worry of damage, pain, future +/- diagnostic uncertainty

After Intervention

1. Conscious Non-Protection - Purposefully relaxed, fluid, free movements and postures that reduce pain and increase function (including integration into valued activities)
2. Non-Conscious Non-Protection - Automatic, natural, relaxed, fluid, free movements and postures secondary to positive experiences that disconfirm or violate previous beliefs, worries or expectations, and individualised education about their condition and the meaning of pain

Cognitive Functional Therapy (CFT) is the mastermind of australian Physiotherapist Peter O'Sullivan, and now has numerous research papers highlighting the benefit of this intervention in people with Chronic Lower Back Pain. I had the honour of participating in one of his courses last year and have successfully used this intervention in a number of clients.

So, if you are experiencing long term lower back pain, speak with me today on either enquiries@mattrossphysiotherapy.co.uk or 07814 717577 to see how I can help.

I look forward to hearing from you!

Matt Ross

Recently. the UK Government announced changes to their guidance and laws on how to manage the COVID-19 Pandemic. According to the recently published 'Living with COVID-19', regular asymptomatic testing and required self isolation should you test positive has been removed. However, the UK government still recommend:

• Wearing a face covering in crowded and enclosed spaces
• Testing if you do develop symptoms (the NHS still suggest that a temperature, loss of sense of taste or smell and a new continuous cough are the most common signs)
• Stay at home if you are unwell
• Regular hand washing

The current recommendations the Public Health England Infection Protection and Control Teams is that PPE shall continue within a healthcare setting until advised otherwise. Therefore Matt Ross Physiotherapy shall continue with:

• The wearing of full PPE
• Strict cleaning procedures both before, after and inbetween patient appointment times
• Sufficent gaps in between patients to ensure adequate social distancing

While facemasks have not been mandatory for a while now, the clinic has a broad range of clients from different ages and diffent medical conditions and I have a duty to ensure everyones safety during this time. I therefore kindly request that all clients continue to wear a face covering whilst on the premises (unless medically exempt or for any other valid reason).

If you feel unwell, please do not attend your appointment and notify me so we can arrange at your earlies convenience

This guidance will be reviewed on the 1st April 2022. Many thanks for your continued support.

Matt Ross Physiotherapy has been established for almost 3 years and throughout this time I have had the pleasure of helping hundreds of clients with various conditions.  Since the very start I have always aimed to provide professional, evidence based physiotherapy ensuring people receive interventions based on the recent scientific evidence and I am delighted to receive positive feedback as well as recent awards from Global Health and Pharma.

As a result of increased demand I am delighted that the clinic has changed it's opening times to enable more people to receive the very best physiotherapy in Chelmsford. The clinic times are as follows:

• Monday to Wednesday: Closed
• Thursday to Saturday: 8.30am to 6pm
• Sunday: 10am to 4pm.
• Emergency appointments may be available at request - please contact directly.

Booking appointments has never been easier and can be done by clicking the 'instant booking' located at the footer of the webpage. This is the very first step in developing the services and availability of the clinic and I am looking forward to many more exciting developments in the next to distance future!

Kind regards

Matt Ross