Aching pain is usually an inflammatory condition that occurs after a gradual onset of a condition. You may be doing a repetitive activity or be over using a particular posture without adequate recovery and this may lead to an ache type pain.

Sharp Pain is usually a localised sprain, strain or tear of a structure. 

You may have lifted more than your limit or bent further than you maximum ROM allowed. Structures causing this type of pain may be muscles, ligaments, joints or joint capsules.

Shooting, burning, numbness, pins and needles, tingling, radicular or referred pain may all be grouped together and these symptoms give us a clue tending toward nerve related pain. The nerve may be blocked or stretched or compromised allowing for more specific investigation.

Symptoms of lower back pain include 

• A dull aching pain, which often becomes worse with movement 
• Sharp pain, that feels like a stabbing or burning sensation 
• Muscle spasms 
• Stiffness and difficulty in moving, bending or standing up straight 
• Pain that radiates (may extend to the buttocks, legs or feet and commonly seen in sciatica conditions that impact sleep). 
• Numbness or tingling or a feeling of pins and needles especially when a nerve is impacted. 
• Limited range of motion when bending, lifting, twisting or standing up straight 
• Pain worsens with prolonged sitting standing (think sitting in a movie theatre or at your desk). 

If your back pain is accompanied by severe abdominal pain, fever or loss of bladder control it’s important to seek urgent medical attention or go to the ER. 

• Slipped disc
• Bulging disc
• Herniated disc
• Radicular pain
• Radiculopathy 
• Nerve root impingement
• Pinched nerve
• Muscle strain 
• Paraspinal muscle strain 
• Quadratus Lumborum muscle strain 
• Erector Spinae  

All these words are some of the common diagnostic terms linked to lower back pain. 

There are many muscles in your back that help you bend forwards and backwards and to twist from side to side. 

Exerting too much force either repetitively or in a single effort may cause a muscle strain that may be very painful. 

Usually, because the muscles of your back help with posture, even doing the smallest movement, once you have a muscle strain, can cause a lot of pain.

Thankfully, if managed well, muscle strains resolve completely within 6 weeks.

Your spine is composed of bones called vertebrae. 
Each vertebra has a bony notch or curve called an exit foramina. 
This location is where nerves exit the spinal cord and go out to supply different parts of the body. 
The size of this exit foramina is very important. 

If the size becomes too small the nerve may be compressed, setting off pain either locally at the point of compression or worse down the length of the nerve.

Radicular pain that shoots down the buttock and thigh and sometimes all the way down to the big toe is known as sciatic nerve pain or sciatica. 

Depending on the reason for the radicular compression, pain management will be different. 

If the reason for compression cannot be changed, for example in cases of advanced arthritis or spondylosis, or in cases of other bony abnormality like bone loss due to fracture or surgery, then managing the condition is much harder vs if you have a muscle overuse injury that may be treated with much better outcomes.

Although we pride ourselves on minimally invasive first, at Replay Health we know there is a place for surgery when symptoms do not improve after three to six months of minimally invasive treatments.  

We can refer you to a range of multidisciplinary experts including orthopaedic surgeons, spine surgeons, psychologists and occupational physicians.

Spondylosis is osteoarthritis of the spine.

Osteoarthritis is a degenerative joint disease and like elsewhere in the body, (such as in hips, shoulders and knees), joint space narrowing, osteophyte development, decreased ROM, pain and stiffness progressively worsen. 

Early intervention, often with safe exercise guidelines are important components of managing this disease.

This is a  condition where one vertebra of the spinal column slides forward over the level below it causing the spinal cord that runs between the two vertebrae to be compromised.

Vertebrae of the spine contact each other at the heavy weight bearing location known as the vertebral body and at smaller areas to the side of the vertebral body known as “Facet, Zygapophyseal or Z joints”. 

Like any joint of the body, if a Z joint is stretched beyond its limits, an inflammatory response may ensue. 

Managed well, an injury that does not involve a boney change will resolve favourably.

The SIJ is the bottom of the spine where vertebrae are replaced by a bone called the sacrum. The sacrum is part of the pelvis and where it joins the ilium bones of the pelvis it is known as the Sacroiliac Joint. 

The SIJ does not move much and takes on a lot of weight bearing for the spine. 

When this joint is injured it is often confused with hip pain.

Commonly, Lower Back Pain persists and becomes sub acute or chronic pain. Once you have had pain for more than 3 months, factors such as psycho-social influencers effect your pain. 

Having a positive attitude toward the diagnosis and outcome of pain both from your own point of view (psycho), and from others around you (social), you are more likely to have a quicker positive outcome.

This is easy to say, but not always so easy to do, so we work closely with a multidisciplinary team of psychologists, worker injury surgeons, injection nurses, pain specialists, interventional practitioners, occupational therapists and others to ensure you can return to life and work faster.

Symptoms include of Upper Back Pain include 

• Aching between and around the shoulder blades
• Burning under the shoulder blades
• Stiffness with rotation and breathing
• Stabbing, sharp pain when taking a deep breath 
• Radicular pain that radiates to shoulders, arms and chest 
• Sharp pain between the shoulder blades 

• Muscle strain after lifting heavy objects
• Prolonged poor posture particularly sitting or standing with improper alignment 
• Sudden impact trauma from falls, sports injury,, worker injury or accidents 
• Herniated disc between the vertebrae that can bulge or rupture, pressing on nerves 
• Myofascial pain of the connective tissues, often caused by repetitive motions or stress. 
• Osteoarthritis or degeneration of joints of the upper spine that causes pain and stiffness. 
• If you’re experiencing overlapping pain from the neck to the upper back and vice versa, you need a comprehensive approach to treat both areas. 
• Kyphosis  or forward curvature of the upper spine leading to a hunched posture. 
• Scoliosis – a sideways curvature of the spine that causes upper back pain. 
• Stress – Mental and emotional stress can cause muscle tension and spasms in the upper back. 
• Obesity – Excess weight puts strain on the spine and back muscles. 
• Pinched nerve – a frustrating and painful condition that causes nerve compression, pain, numbness or tingling. 
• Fractured rib or popped rib cartilage – your rib cage is made up of both bones – ribs, and rib cartilage. If an impact or trauma to the rib cage occurs, either a rib may break or fracture directly, or the end of the rib that connects to the rib cartilage may dislocate or “pop” out. Both of these events are quite painful and require a rib support strap and education regarding breathing safety.

• Commonly Upper Back Pain is caused by a prolonged episode of poor posture with associated hunching forward of the Upper Back. The best way to treat aching Upper Back Pain (UBP) is to gently stretch back over an arched object. You may start by sitting in a chair and using the back of the chair to pin point your pain as you lean back over it, or you may prefer to lie on the floor and use something like a ball (choose a size ball right for you) and position it until the stretch feels in the right spot and strong enough.

The longer you have had pain the longer it may take to treat.

Acute and Sub Acute Back Pain

• For acute and sub-acute pain (pain lasting not more than 3 months), it is important to find the cause of your pain and remove it. This may sound simple, but you may be challenged by whats causing the pain and things you have to do – like working long hours on a computer, or moving house and lifting a lot of boxes..
• Once you have removed the cause of the pain the next step is to determine safe movement versus unsafe movement. An easy way to work this out is to set a pain boundary. Using the VAS pain measurement scale where you score pain from 0/10, where there is no pain at all to a maximum of 10/10 pain, that is the worst pain you can imagine, safe movement is movement defined by no more than 5/10 pain.
• The McKensie method for back pain is a very useful practice Physiotherapists use to assist with the recovery from back pain. It is a progressive treatment where gentle movement encourages safe healing.

Chronic Back Pain

• Pain lasting longer than 3 months is defined as Chronic Pain. It has been shown that people suffering pain for longer than 3 months have physical changes to their brain. This means that ongoing pain is a recurrent stimulus that causes the brain to adapt and change.
• This adaptation of the brain changes the way pain is perceived by the individual. Like a car has a beeper that is used to determine how far a wall may be away from the back of it, our brains use pain as a warning signal. When persistent recurring pain signals are sent to the brain for longer than 3 months, the interpretation of the signal changes.
• Taking a Bio-Psycho-Social approach to the management of chronic pain is necessary to deal with all the factors influencing pain, not just the original condition itself.
• Bio- refers to treatments a Health Professional can prescribe to you. Treatments include non-invasive treatments from a Physiotherapist such as stretching, manual therapy and massage as well as guidelines and education to help you avoid pain or exercise guidelines that help you move safely. They may also include doctor prescribed medications, injections or more invasive treatments such as surgery.
• Psycho- refers to how much time you spend dwelling on your pain. Those that dwell longer on what their pain, such as over thinking about what it could be, why is it happening to them, what if they tried this, what if they tried that etc, will have worse outcomes than those who dwell less on their pain. Distraction techniques are important in managing how to avoid dwelling on pain. 
• Social- refers to the influence others have on our own pain. Like a coach or a role model, we can have good or bad. As obvious as it sounds, an optimistic outlook from a health Professional, family member or friend will provide the best opportunity for an optimistic outcome while a negative outlook will only help drive a poor outcome.