Back pain

Back Pain affects 8 out of 10 of us at some point during our lives.

Acute Back Pain is usually caused by a strain or sprain to the muscles/structures in the back and happens to most of us at some point during our lives.  Back pain can occur suddenly or develop over time and be caused by lifting, twisting or moving awkwardly, but often develops without any specific memorable injury to your back.  Back pain can range from a mild ache to quite severe pain which is very distressing and can stop you doing everyday activities at home or work.

Chronic back pain refers to pain that has not gone away after three months. Similar to acute back pain it is usually caused by a strain or sprain in the back, although the pain and distress can last much longer and have greater effect on your daily activities. This type of pain can range from a mild ache to more severe pain.

Chronic pain can be influenced by a variety of reasons including how happy you are at home or work, if you are prone to depression or have had back pain before.
Often people think the best thing to do is lie down and rest – STOP – this is a myth and movement, pain relief and expert advice is the best way to remedy the situation. Knowing the facts means you will worry less and recover sooner.

Acromioclavicular joint pain

Acromioclavicular joint pain occurs where the collar bone meets the shoulder blade. Pain in this joint can occur if you carry out a lot of activities that require you to lift your arms above your head.  Making changes to the amount of overhead activities you do can ease the pain. Painkillers can manage the symptoms, but seek advice from a pharmacist before taking. If the pain is persistent, contact your GP as physiotherapy will also help.

Injections can be given to settle the pain if it is severe, and if the pain does not improve surgery to remove the end of the collar bone may be considered.

Back and neck pain facts

When I have back pain I should go to bed and rest

FACT- When suffering with back pain you may think the best thing to do is rest in bed for days until the pain has reduced.  Although a small amount of rest during the day may be good for you, the best thing to do is carry on with normal activities as mush as possible.  This will be made easier by taking suitable painkillers, seek advice from your pharmacist, health professional or doctor.

I can’t return to work or sports until I am completely pain free

FACT- Activity is good for the body and your spine in particular.  Work will not be bad for you and you will not damage your spine by returning to work.  However you may still experience some pain whilst participating in work or sport related activities but this tends to improve with time.  Keep moving and follow the advice from your health professional or the PhysioHey self help section.

My back pain must be something serious like cancer

FACT – Back pain is usually caused by a strain or sprain of the spinal muscles or ligaments.  Only approximately 1% of people presenting with back pain have something potentially serious causing the pain.  Your health professional will ask you a series of detailed questions which will enable them to ascertain if your pain is anything more than a sprain or strain.

I have had back pain for a few months; this must mean there is something seriously wrong.

FACT – Back pain tends to run in good and bad periods which is entirely normal. If you are worried about how your back pain is progressing visit your GP or contact your local MSK Service

I have been told I have arthritis in my spine, does this mean my spine is crumbling?

FACT – No, your spine is not crumbling.  Arthritis is often used to describe ‘wear and tear’ or may use the medical term ‘spondylosis’ but they mean the same thing.  Both terms describe the aging process of bones and joints in the same way as hair goes grey and skin wrinkles, bones and joints age also and this is arthritis.

I have had a number of tests carried out by my doctor which were all normal, does this mean I am imagining my pain?

FACT – Definitely Not! The tests were performed to check for specific diseases or conditions and if the result was negative then it simply means you do not have the condition that specific test identifies and it does not your pain isn’t real.

I need an x-ray to diagnose my back pain or sciatica.

FACT – No, x-rays are not very good at providing the cause of back pain, other than arthritis which most of us have as we grow old.  PhysioHey Health professionals request x-rays and scans only when clinically appropriate and works uses guidelines based on best evidence that are agreed by consultants from Orthopaedics, Neurosurgery and Radiology.

If I have back pain or sciatica, will I need an MRI scan?

FACT – MRI scans do show a clear picture of the spines bones, discs, joints and nerves.  However, this level of detail is usually only required when your health professional thinks there may be a need for surgery.

Frozen shoulder

Adhesive Capsulitis or Frozen Shoulder is the painful gradual stiffening of the shoulder capsule (tissue surrounding the shoulder joint). This painful stiffening leads to disturbed sleep and reduced ability to use your arm for day-to-day activities. The exact cause is unknown but following a minor injury to the capsule the body produces excessive scar tissue as it attempts to heal the capsule. 1 in 20 people are affected and it is more common in women than men. Frozen shoulder mainly occurs between the ages of 40 – 60.

Frozen shoulder is categorised into three phases:

  • Painful Phase
  • Stiffness Phase
  • Thawing Phase

Why did I get it?

The exact cause is unknown but it has been related to an overactive response to a minor injury and attempts to heal the capsule with scar tissue resulting in a stiff painful shoulder.  If you have diabetes or have had recent shoulder surgery you are more likely to develop the condition.

What happens to the shoulder when I have a frozen shoulder?

Painful phase – there is increased blood flow to the shoulder capsule to lay down new tissue, this causes pain similar in sensation to toothache and is why the shoulder is more painful at night especially when you lay on it.  This phase may last 2 to 9 months (longer in diabetics).
Stiffening phase – scar tissue forms around the shoulder capsule making it difficult to move, during this phase the pain is usually more manageable and sleep is less disturbed. In addition to the stiffness muscles may start to waste as the shoulder is not being used as much.  This phase may last 4 to 12 months
Thawing phase – your shoulder will start to loosen and will slowly become easier to move.  This happens as the body breaks down unnecessary scar tissue and the capsule becomes more flexible once again.  This can last from 5 months to 4 years, in some cases full range may never return

How do I manage it?

Activity modification/relative rest

Activity modification does not mean you stop moving or using your shoulder altogether. Although it sounds straightforward, avoiding activities over your head or behind your back can help to reduce the irritation of your shoulder.

Maintaining good posture

Your shoulder movement can be hugely affected by your posture. If you slouch, your ability to lift your arm above your head reduces by approximately 30 per cent.

Sitting and standing in a good posture with your shoulders back will help your movement as well as prevent the tendons in your shoulder catching. Also try not to slouch and lean through shoulders and elbows. This squashes all the structures in your shoulder against the ridge above the joint, causing pain and irritation.

Simple analgesia and anti-inflammatories

Simple analgesia such as paracetamol can be used to dull the pain but does not cure the problem. Anti-inflammatories such as ibuprofen can also be effective. It is best to consult your health professional, pharmacist or GP if you have not taken these before.

Ice/Cryotherapy

Icing your shoulder can be a very effective way of reducing your pain. Place a wet flannel and a pack of frozen peas on your shoulder for up to 20 minutes every hour. Check the skin under the ice every five minutes to avoid an ice burn. Once the pain begins to settle you can then start to ice your shoulder less frequently.

Injection therapy

Injection therapy can be a very effective way of reducing your pain during this stage if anti-inflammatories or ice are having little effect. This can be done by either your specialist GP or by an enhanced role physiotherapist. Injections are not for everyone and may not be suitable for those with certain medical conditions.

Simple range of movement exercises

Please see video of shoulder range of movement exercises by clicking here.

Neck pain

Neck pain may be caused by poor posture, arthritis or accidents. Whiplash is when the head is thrown violently forwards and back, as sometimes happens in car accidents.

Similarly to back pain, neck pain is common in people of all ages and is usually caused by sprain, strain and how we use our necks.  As we spend more of our working day using computers or sat in an office environment our necks and shoulders can become overused and/or stiff.  Neck pain is influenced by factors such as stress and tiredness. Continuous pain may be osteoarthritis in origin (age related changes as with the back), this may result in stiffness as well as muscular related pains in the neck and shoulders.

If a nerve in the neck is being irritated by another structure this can cause pain to go down the arm in to the hand with or with out pins and needles or numbness.  These symptoms can be treated and resolved in the majority of cases by your health professional.

If you are experiencing arm weakness you should contact your doctor.  Occasionally the nerves in the neck become trapped making it difficult to use your hands for tasks such as unscrewing jars, doing/undoing buttons or can make you lose your balance when walking, if this occurs again you should contact your doctor

Please refer to exercise video for neck range of movement as the first step is to try and ease your symptoms through movement.  Movement is likely to be sore and this will be helped by the use of pain killers such as Ibuprofen and/or paracetamol (always read the box or ask your pharmacist for details on how to take them or possible interactions with other medication you may be taking).  If your neck pain is worse when working please discuss this with your employer as you may require an assessment of your workstation which your employer will be able to organise.

If your neck pain does not improve please contact your GP.

Neck Rotation Video

Top tips to prevent neck pain

  • Check your posture, so that you hold yourself comfortably upright
  • Gently strengthen your neck muscles, to help support your head
  • Take regular breaks from desk work, driving or any activity where your neck is held in one position
  • Keep your neck active and mobile to prevent stiffness but avoid bending your neck back though
  • Avoid reading for long in bed or using too many pillows
  • Shrug and lower your shoulders to ease tight muscles
  • Check your eyesight in case reading is making you stoop
  • Practice relaxation if you are prone to stress, to reduce tension across your shoulders and neck

Osteoarthritis

Osteoarthritis of the shoulder is the gradual wearing away of the cartilage of the joint. This leads to the two bones of the joint rubbing together, causing pain.  If you have experienced previous trauma or shoulder surgery you are more likely to develop osteoarthritis later in life.  The symptoms may include swelling, stiffness, aching and sharp stabbing pains.

There are a range of exercises that will assist in strengthening the muscles around the shoulder and prevent loss of the shoulders range of movement which, in turn, will help reduce the symptoms of osteoarthritis.  Please see the shoulder exercise in our video section.

Referred shoulder pain

Referred shoulder pain is when you experience pain away from the area that is actually injured or is causing a problem, e.g. pain in the shoulder which is usually referred from the neck or upper back.

As with frozen shoulder and instability, bad posture can be the main cause of referred pain in your shoulder and it can often be managed by merely improving your posture and keeping your neck moving.

Rotator cuff pain

The rotator cuff is a group of muscles that help control the movement of the shoulder's ball and socket joint. If this control is impaired the muscles can become stressed or compressed between two bones, causing pain in the shoulder or upper arm, usually when lifting the arm, lying on it or using the weakened sore muscles.

When your work and/or hobbies require putting hands above shoulder height you may develop rotator cuff problems.  Although a shoulder injury, repetitive movements may cause the condition to develop.  These problems can be age related and may be something that develops as you age.

What happens to cause the pain?

In most cases the muscles become painful without any serious damage and respond to self management advice, but in some cases the tissues become inflamed and may show evidence of degeneration or develop a tear.

What are the symptoms?

Pain in the shoulder or upper arm, usually when lifting the arm, lying on it or using the weakened sore muscles.

How can I resolve the pain?

Relative rest from activities that aggravate the pain and symptoms

Pain relief as advised by your health professional, pharmacist or doctor

Gentle exercises to stop the shoulder getting stiff and to rehabilitate the muscles

What should I do if it doesn’t improve or the symptoms are very severe?

Contact your doctor who provide you with any necessary pain relief and refer you to physiotherapy where you will recieve advice on posture, maintaining movement and increasing strength.

You may require investigations such as X-ray or ultrasound

You may require a steroid injection or ultrasound guided injection

You may require surgery. In this scenario your health professional will guide you through the clinical decision making process. Your case may be reviewed by a consultant before the referral is made to ensure all avenues of treatment have been considered.

Avoidance and prevention of reoccurrence

Avoid excessive unusual activities with your hands above shoulder height, consider breaking tasks such as curtain hanging or decorating into short bite size periods of time

If you exercise, try and balance your programme to include strength work for all muscle groups

Take a break from heavy or repetitive shoulder movements/lifting

Downloads

Sciatica

What is Sciatica?

The term refers to pain that travels down the back of your leg from the lower back or buttock as far as the foot.  This is caused by irritation of the sciatic nerve and is often accompanied with back pain but more often the leg pain is worse than the back.

Cause

Nerves leave the spine through small tunnels made by the bones of the spine.  Some of the nerves in the lower back merge to form the sciatic nerve which runs down each leg. This happens on both sides of the spine so you may suffer sciatica in either leg.  If the nerves are irritated where it travels through the tunnel due to a swollen joint, muscles or ligaments or a bulging disc, in some cases pain can occur anywhere along the length of the sciatic nerve.

Why does the pain travel down the leg?

This is because of the nerve irritation described above. The irritation leads to severe shooting pains traveling down all or part of the sciatic nerve along its path in the leg; this may be accompanied by pins and needles and/or numbness.  The sciatic nerves send messages to the brain about the irritation and makes the brain think there is a problem with the nerve itself and not in the back which is the cause of the pain.

What should you do?

As with other back or neck related pains the key is to keep active but you may need pain killers to achieve this, and you cannot do yourself any harm in doing so.  Following either a GP consultation or appointment with PhysioHey you will be given advice and exercises.  Advice will relate to keeping active which will stop your muscles becoming tight and weak, which may cause problems in the longer term.  You will experience some pain and discomfort during your recovery but this is not harmful.

Are there signs or symptoms to be concerned about?

Sciatica is rarely a sign of a serious problem, but is unpleasant when you are suffering this form of pain. The pain experienced does not mean more damage is occurring.  Many cases of sciatica resolve without specialist input when given good advice and most others resolve within 4 weeks.

However if you experience the following you should seek urgent help;

  • Being unable to pass urine when you feel the need to go
  • Lose control of your bowels
  • Go numb around your bottom/groin
  • Unable to get an erection
  • Have pain in both legs and/or worsening weakness in the legs

If you are unable to discuss the above symptoms with your PhysioHey clinician or a doctor you should attend your nearest Emergency Department for urgent assessment.

Treatments available for sciatica

You should see your doctor or contact your local community MSK service who will provide initial advice and assessment (this may be over the telephone) as well as advising on pain relief if you are not already taking some.  It takes time for symptoms to start settling down. If they are not improving you may be required to attend for further assessment and treatment.  Occasionally surgery may be required, but you should give you body chance to recover on its own first.

If you need further advice or just need reassurance things are progressing as they should contact your doctor or local community MSK service.  Their expertise will quickly ascertain if your symptoms have changed or deteriorated and will modify your treatment and/or pathway.

Back pain is a ‘musculoskeletal disorder’ (MSD) which also includes neck pain and repetitive strain injury (RSI), now known as Work Relevant Upper Limb Disorder (WRULD).  MSDs are a main cause of people being off sick from work.  Physiotherapy is extremely effective with MSDs. In one study, 80 per cent of people who had physiotherapy for their MSD were able to carry on working and did not have to go off sick.  Back pain has a wide variety of causes, from picking up a heavy parcel incorrectly to spending too long in one position.  Feeling very anxious or stressed can make your pain worse.  It is rarely due to a serious health problem.

Physiotherapy work wells for managing back pain. If you see a physiotherapist quickly, this can not only speed up recovery but also prevent the problem happening again.  A physiotherapist will first check out if you have a serious health problem that may be connected to your back pain, this may be done over the telephone in the first instance. They will then find the reason for your back pain and look at ways to help prevent further problems.  Physiotherapy and osteopathy offers a range of treatments that have proven to be effective with back pain. These include manual treatments, exercise, and acupuncture.  You will be advised on appropriate exercise and pain relief.

There is a lot you can do to help yourself. Continuing with your usual work and activities, as much as possible, can help your back pain. There are exercises that can reduce your back pain and help to prevent it returning. The right sort of exercise, as advised by a physiotherapist, can make a big difference.

Research has shown lower back pain may return if it is ignored. Lifestyle changes, such as being more active and improving your posture, are important.

Top tips for back pain

  • Exercise and activity are the most important ways of helping yourself if you have back pain
  • Keep moving and continue with activities such as walking or swimming
  • Paracetamol or similar pain-killers, taken as advised by your health professional , can help you keep moving comfortably
  • Avoid sitting for too long when driving or at work
  • Gently stretch to prevent stiffness
  • Take care when lifting, bending your hips and knees to use the power in your legs
  • Check your posture when using computers/games or watching television
  • Check the mattress on your bed to ensure it supports you properly
  • Don’t smoke – it impairs your circulation, which affects how quickly your body can recover
  • Strengthen your trunk muscles as this may help to protect your back
  • Make sure your car seat and office chair are adjusted correctly and support your back
  • Eat a healthy diet and exercise, as being overweight can be a cause of back pain

For more information regarding back pain and its costs to you and your employer click below;

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Shoulder instability

The shoulder is one of the most commonly dislocated joints.  Instability means that the shoulder can dislocate (be pulled out of joint) or experience subluxation (move more than it should).  The shoulder joint is a ball and socket joint like the hip, but this instbility is more common because the shoulder joint is much more shallow than the hip which allows it to be a very mobile/flexible functional joint.  Both dislocation and subluxation happen for a variety of reasons.

The three main causes of shoulder instability are:

  • Traumatic dislocation – where the shoulder undergoes an injury with sufficient force to pull the shoulder out of joint such as a violent tackle in rugby, or a fall onto an outstretched hand
  • Non-traumatic dislocation –caused by repeated shoulder movements gradually stretching out the soft tissue cover around the joint causing the rotator cuff muscles to become weak, regularly working with your hands above your head may contribute to this
  • Positional non-traumatic – the ability to dislocate your shoulder without any form of trauma. This may start off as a party trick, but if repeated, it can happen during everyday activities. If you are able to do this it is strongly recommended that you don’t

What causes instability?

Traumatic dislocation:

This is where the shoulder undergoes an injury with enough force to pull the shoulder out of joint, such as a violent tackle in rugby or a fall onto an outstretched hand. This much more common in men under the age of 30.

If this happened the shoulder usually requires putting back in position (reduction) in Accident and Emergency. Following a first time dislocation, the arm is usually put in a sling and you may be sent for a course of physiotherapy.

The shoulder joint is a ball and socket joint, which is held together by a combination of ligaments and muscles. There is also a rim of cartilage around the socket called the labrum. The labrum deepens the socket to make the shoulder more stable.

When the shoulder is dislocated, sometimes the rim of cartilage is pulled away from the socket damaging the labrum. Often this does not heal and the shoulder can remain unstable.
Once your shoulder has been damaged in this way, you may find that your shoulder dislocates again fairly easily. This damage to the labrum is often called a 'Bankart lesion'; named after the doctor who first described this injury.

If enough force is present during a dislocation, a small part of bone from the shoulder socket (glenoid fossa) may break off with the labrum. This is often called a 'Bony Bankart lesion'.

Shoulder stabilisation surgery may be required and an operation to repair the damage to the labrum and therefore re-stabilise the shoulder joint will be recommended.  This type of repair may also be called a Bankart repair or a Latarjet procedure by your surgeon.

Non-traumatic dislocation:

Repeated shoulder movements may gradually stretch out the soft tissue cover around the joint (the joint capsule). This can happen with athletes such as throwers and swimmers. Following capsular stretching, the rotator cuff muscles can become weak – affecting how the muscles around the shoulder interact with each other and in turn, leading to an imbalance of the shoulder.

In this type of shoulder instability, referral for specialist physiotherapy is the first form of management and treatment can be effective for as long as exercises are continued.

Posititional non-traumatic:

This condition refers to the ability to dislocate your shoulder without any form of trauma. This may start off as a voluntary dislocation, perhaps as a party trick, but if repeated, eventually it can happen during everyday activities. It can affect both shoulders and can be associated with people who have lax joints. If you are able to do this it is strongly recommended that you don’t

This type of instability is due to abnormal muscle patterning around the shoulder, meaning the strong power muscles around the shoulder, such as the pectoral muscles, are constantly ‘switched on’.

These muscles then pull the already loose shoulder out of joint during movement. The main treatment with for this type of instability is specialist physiotherapy, which looks at retraining movement patterns of the shoulder, using specialist rehabilitation methods and accurately performed exercises.  As with any form of rehabilitation compliance with advice and exercise is key to success.

How can I manage my instability/dislocation?

If you are in a sling following a first time dislocation your physiotherapist or doctor will advise you when to remove it in order to exercise

Change your activity / rest

You can start to move your arm when advised by your physiotherapist or doctor and you should then try to slowly increase your range of movement over the next 3 to 4 weeks.  Making changes to activities does not mean you have to stop using or moving the shoulder altogether but you should try to avoid activities that involve lifting your arm above your head or contact sports in the first 3 months.  Following this advice can prevent future dislocations.

Maintaining good posture

Shoulder movements are affected by your posture. Standing and sitting with your shoulders back in a good position will help your movements as well as prevent the tendons in your shoulder catching on other structures.

Analgesia – Painkillers and / or anti-inflammatories

Pain killers such as paracetamol and anti-inflammatories can be effective in reducing the pain and enabling you to comply with rehabilitation.  If you have not taken these before you should speak to a pharmacist or your GP.

Ice/Cryotherapy

Icing your shoulder can be a very effective way of reducing your pain. Place a wet flannel and a pack of frozen peas on your shoulder for up to 20 minutes every hour. Check the skin under the ice every five minutes to avoid an ice burn. Once the pain begins to settle you can then start to ice your shoulder less frequently (refer to ice and heat information section)

A range of exercises can be found in the video section of our website to help maintain range of movement and strengthen the shoulder which your physiotherapist will direct you towards.

Sleeping

Lying on your shoulder can be very painful, try and sleep on your back or the opposite shoulder with a pillow under the armpit of the affected shoulder.  You should continue to wear your sling in bed until advised to remove it by your physiotherapist or doctor

How do I stop a dislocation in the future?

if you have a history of recurrent shoulder dislocations you should contact your doctor or local Community MSK Service and following assessment by a physiotherapists it may be appropriate to recommence a shoulder stability rehabilitation or your symptoms may warrant referral to one of our shoulder specialist surgeons for a surgical opinion.  Whatever the outcome you will be supported and guided throughout the process.

Before trying to self-manage using the information on this website, if you have any of the following symptoms please contact your GP.

  • Left shoulder pain associated with shortness of breath, clamminess
  • Night pain that prevents sleep
  • Swelling or redness
  • Shoulder pain associated with fever or night sweats
  • Pain following traumatic injury  e.g. fall sports injury, epileptic fit or electric shock
  • Pins, needles or numbness