Back Injuries

The back is a very complex structure, with a delicate spinal cord encased within angled bones at the rear of a column of bones arranged like building blocks. Between these blocks are discs, which have a tough outer casing and a jelly-like centre.

In certain types of back injury, the casing of the disc can split and allow the centre contents to squeeze out. This is referred to as a "slipped disc".

If the disc presses on an adjacent nerve root, it can cause pain along the distribution of that nerve root, down the leg. This type of leg pain is called sciatica.

Other structures that can cause pain when injured include small joints at the rear of the spinal cord. These are called facet joints (between the vertebrae). In some athletes, e.g. fast bowlers in cricket, pain may arise from a stress injury to the bone.

Pain may also arise from irritated muscles which then go into spasm. Other causes of back ache are much rarer and include infiltration of the bones of the spine with tumour deposits from spread of a cancer elsewhere in the body.

The exact identification of which structure is causing the pain is often difficult, and is not necessary in most cases.

What symptoms occur?

Back pain, generally at the level of the structure that is injured Leg pain down the back of the leg if a nerve root is being irritated or pinched

Muscle weakness, if persistent squeezing of a nerve root occurs,

Pins and needles in a particular part of the leg or foot if persistent squeezing of a nerve root exists Rarely, disturbance of bowel or bladder function (e.g. inability to pass urine) may occur. This is serious and requires urgent evaluation in hospital

What treatment is recommended?

If these are not present, the following advice is recommended:

Avoid activities that provoke pain, at least in the first few days after injury. Bed rest is rarely needed, but if so, it should be limited to 2 days or less. Longer periods of bed rest can impair recovery.

If back or leg pain is significant, regular doses of analgesics (pain killers) are advisable in the first week or two.

Gradually increase physical activity over the first week or two as symptoms subside. Manual therapy can be very helpful in the first few weeks after a back injury. Physiotherapists, osteopaths, chiropractors and some doctors are trained to provide this treatment.

Most back problems resolve rapidly - within days to weeks. Pain relief and manual therapy can speed progress in the early stages. Leg pain (sciatica) may require an epidural steroid injection..

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