Physiotherapists in Manchester treat many different conditions including the issues profiled below.

Repeated Loading of Lumbar Discs

Lower loads than the sudden compression loading which occurs seldom can cause a disc prolapse if the loading in a bent position is repeated in a cyclical manner. This can be caused in discs which are reasonably young and causes a large split in the rear of the disc wall to one side or another, allowing the central nuclear material to ooze out. In several examples the layers of the disc wall which were the most outer ones did not split and form a fissure and the nuclear material protruding through the fissure inside built up behind the remaining layers in a bulge. As the ligament overlying this has many nerve endings, such a bulge could cause pain.

Older discs were shown in some cases to have fissures which are already present before any experimental loading and these discs did not prolapse during the loading tests, perhaps because the fissures had healed or because discs in poorer condition are too stiff and fibrosed to prolapse. If twisting, side bending or compression is added to bending then prolapse can occur more easily with less bend of the back. In some cases the nucleus may protrude out but in others the outer disc walls can protrude themselves.

The Course of Low Back Pain

Low back pain is always described as being either acute, sub acute or chronic with acute pain lasting less than six weeks, sub acute pain from six weeks to twelve weeks and chronic pain lasting over the twelve week point. Most people were assumed to recover quickly and go back to normal with only a small number suffering longer term pain and disability. However, research has shown that it is an episodic and recurring condition and present for much longer than generally thought. 75% of patients with back pain in primary care still had symptoms a year later in one study, indicating back pain is more of a chronic picture overall.

Patients with chronic back pain are not uniformly severe or disabled but rather suffer a varying degree of pain and disability over time. Old views used to be that 80-90 percent of back episodes resolved completed but it is much more realistic to view it as a longer term grumbling problem. The main predictor for people having back pain in the future is having had it in the past and this supports the above idea of back pain as a continuing problem. For most people back pain is a common but limited irritation which recurs from time to time.