Physiotherapists in Marlborough 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.

Back Pain - Red Flags for Serious Conditions

Most people with back pain have just that, back pain secondary to injury, time and the mechanical stresses of holding a posture or performing an activity. However, a small proportion of people present with back pain when the underlying reason is a serious pathology of some sort. The signs that indicate that mechanical back pain may not be the reason for the patient's pain are called red flags. Physiotherapists routinely ask the red flag questions to try to exclude the likelihood of a patient having a serious underlying condition which might also be worsened by physio treatment. Examples of red flags for back pain are: age over 55 or under 20 when back pain first presents and significant trauma involved (like a fall).

Other red flags include: significant weight loss; significant night pain; use of steroids; a history of cancer; bladder or bowel disturbance and loss of sensation in the saddle area around the genitals and anus. A degree of judgement is required as the outcome of the questions is rarely clear cut and most red flag situations turn out not to be serious conditions but physios routinely evaluate these to ensure safe treatment and refer questionable cases on for medical evaluation.