Q I’ve suffered back pain on and off for a few years, and had many different diagnoses. Why is it so hard for specialists to come up with just one reason for my problem?
A Studies suggest that – despite going to a GP, and then being referred onto a specialist, and having X-rays and MRI scans – back injuries are only accurately diagnosed in 14 per cent of cases.
The most common structures to cause back pain are: the pelvis (sacro-iliac joint), the facet joint (locked or inflamed) or a nerve (tethered or inflamed). Discs can also cause symptoms, but a true prolapsed disc is not very common. All of these problems can cause quite marked muscle spasm, which can often cause more pain than the injury itself.
As the body is a truly integrated system, we can take the pressure off one group of structures by treating another – we don’t necessarily need to treat the nerves directly, for example, to help them. So, for any specialist that you see, there are a number of combinations of treatments that can be employed to help your pain.
For example, your back pain may be coming from the pelvis, as any dysfunction here can increase the pressure on the spine and cause symptoms in the back, while you may not have any problems with the spine itself. If the pelvis is rotated, it can make one leg appear longer, and this can affect the way the spine compensates, which can increase the pressure on your facet joints and discs, which in turn can lead to muscle spasm and pain.
There are many combinations of causes and management; the key is to find someone who understands how the whole system works, and how the structures affect each other. Then you need someone to teach you to deal with the problem yourself as much as possible.
—Martin Haines, sports medicine specialist
