Institue of Sport and Exercise Health
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Back pain is one of the most common symptoms that people experience and it is rare that one will not experience back pain at some point in one’s life.  It is a reflection of wear and tear within the lower back, although the frequency and severity of back pain is not always proportionate to the degree of wear and tear changes that may be evident on the scan. 

The back is a very complex structure and there are a variety of anatomical sources that can cause back pain.  The key to isolated back pain is that it will be coming from the mechanical structures in your lower back, rather than the nerves passing through the back.  Any compromise of nerves passing through the lower back results in sciatica rather than lower back pain (hyperlink).  The most common structures in the back to cause pain are the muscles, the facet joints or the discs.  Often, it is a combination of pain from these various structures due to degenerative changes (spondylosis). 

Undoubtedly, back pain is more troublesome if there is underlying degenerate change.  However, on occasion people will get lower back pain without significant underlying spondylosis related to soft tissue strain in their back.  If this is the case, it is likely to be short-lived and self-limiting. 

In others, back pain can become a frequently recurring problem or indeed a longstanding persistent problem.  Inevitably, there will be a degree of spondylosis underlying back pain in these situations.  Unfortunately, there is no treatment that can reverse underlying degenerative changes and, therefore, treatment needs to very much be aimed at improving the symptoms of pain.

This can involve a variety of techniques.  A large proportion of this will be physical techniques such as physiotherapy, as well as other techniques such as osteopathy and chiropractic treatment.  It is not uncommon for one of these forms of treatment to succeed after others have failed.

Other pain management techniques can vary from advice on painkilling medication to more invasive painkilling techniques such as steroid injections into the spine.  Injection therapy will depend on an understanding of what might be causing the pain.  For example, if it is felt the facet joints are making a significant contribution, steroid can be injected into these joints in the same way that other arthritic joints elsewhere in the body can be injected.  This will bring temporary relief from the arthritic pain but used in combination with other physical techniques such as physiotherapy, can often bring more lasting benefit.

In our opinion, surgery has very little role to play in the management of pure back pain.  Surgery is far more usefully employed when there is neurological compression giving rise to sciatica or claudication (hyperlink).