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Back Pain and Sciatica. When to Worry!

Back Pain and Sciatica. When to Worry!

Back pain and sciatica are both very common problems but tend to be a great source of worry and anxiety.

Back pain and sciatica can be very severe in nature and can often cause difficulty moving, sleeping or getting comfortable even when sitting still.  

However, severe pain does not always indicate severe pathology.  For example, some people can walk around with a severe underlying pathology such as an aneurysm with no symptoms at all and may never have any problems!  But, stub your little toe on the corner of the sofa and you most certainly know about it!

Lower back pain and sciatica pain while very painful, are rarely caused by something worrisome, and most episodes of pain improve with time and can be greatly helped with physiotherapy.

Most pain is caused by some of the many muscles that are around the spine or pelvis, issues with the facet joints (the joints between the vertebrae) or the discs between each vertebra.  It is quite uncommon for it to just be one structure to act in isolation as a disc bulge or facet joint issue will quite often have associated muscle spasm thrown in for good measure!

As physiotherapists, we normally ask “screening” questions when someone attends with low back pain, these questions are to help identify if your back pain is something we need to be more concerned about.  If you present with the following symptoms, you should seek urgent medical care.

  • Numbness around your “saddle area” (your bottom, perineum and genitals. Can you feel when you are cleaning yourself after you have been to the toilet?).
  • Loss of bladder or bowel control (not being able to pass urine or becoming incontinent).
  • Gait disturbance and neurological deficit affecting both legs (stumbling, loss of sensation or power in both legs).

Thankfully, these symptoms are extremely rare.  Physiotherapists will often carry out a neurological assessment during their session to check for any issues.

If your back pain is following a significant trauma, particularly if you have a history of cancer, osteoporosis or long-term steroid use.  Or you have had rapid, unintentional weight loss or fever you should speak to your GP regarding your symptoms.  Your physiotherapist will take a detailed history of your symptoms and medical history and can advise you if they feel further investigation is needed.

The take home message is back pain is extremely common and can be incredibly painful but is rarely something to worry about.  The vast majority of back pain responds very well to physiotherapy care without the need for scans or further intervention.  Speak to one of our physiotherapists about any concerns you may have, and they will be happy to help! 

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