Mechanical Back Pain
1. Introduction
Mechanical back pain originates from internal structures, including the spine, its connecting joints, and surrounding soft tissues. It is the most common type of back pain, affecting about 8 in 10 people at least once in their lifetime (1). Although distressing and disabling, it is rarely dangerous and usually self-limiting, meaning it will resolve without treatment. In most cases, there is no clear underlying cause for the pain. This is often referred to as “non-specific,” as it cannot be attributed to a specific structure, pathology, or disease (5). The spine itself is strong and resilient, not easily damaged. It is widely accepted that a sprain or strain of a ligament or muscle, and/or minor issues with the discs or facet joints between vertebrae, may cause mechanical back pain (2). Most people recover from mechanical back pain quickly, with some not needing any treatment at all. Mechanical back pain usually presents as a sudden-onset (acute) and may be present for up to 6 weeks. In some cases, persistent (chronic) pain may develop (2,5).
Frequently Asked Questions
- Mechanical back pain simply means that the source of the back pain that you are experiencing can be explained by one of the main structures of the back, such as the joints, bones and soft tissues.
- Mechanical back pain is extremely common.
- 60 – 80% of people in the UK report back pain at some time in their lives (1).
- For most people, low back pain is simple and will resolve without treatment; serious specific causes are rare (1,2).
- No.
- The majority of cases of mechanical back pain respond well to exercise, advice and simple pain relief.
A small percentage of back pain can be associated with serious pathology and therefore it is important to monitor for:
- Saddle anaesthesia or paraesthesia (numbness or altered sensation around the genital region).
- Recent onset of bladder dysfunction.
- Recent onset of faecal incontinence.
- Perianal/perineal sensory loss.
- Highly demanding jobs, prolonged standing and awkward lifting are the most consistent factors predisposing to low back pain (3).
- People who are overweight or obese (4).
- Significant work-related stress.
- Those who had a previous occurrence of back pain.
- Family history of back pain.
- Pain and stiffness in the back, exacerbated by certain movements and eased by others.
- Occasionally some people also get some associated leg pain from nerve irritation.
- Modify your activity.
- Advice from a qualified physiotherapist will be helpful in most cases.
- Undertaking regular gentle exercises for mobility and strength of the spine.
- It is important to stay active and continue to use the back and spine to avoid it becoming weaker and stiffer.
- This will depend upon several factors including, but not limited to, medical/lifestyle factors, stage of injury, your ability to follow your rehabilitation, etc.
- Everyone is different but consistently undertaking a back rehabilitation programme prescribed by your physiotherapist should allow significant improvement in symptoms within 6-12 weeks.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
- Pain may be very localised to one specific area or may radiate into buttocks/thighs and other areas of the back.
- Pain may be exacerbated by certain positions or movements and may be eased by others.
- The pain intensity may vary depending on activity or posture.
- Other activities, such as coughing/sneezing, may exacerbate symptoms.
- If there is irritation of the nerves that exit the side of the spine, you may experience some pain or altered sensations going down your leg (1,2).
3. Causes
- In many cases, the definitive cause of mechanical back pain cannot be reliably identified. This should be reassuring as that means there is no serious disease or pathology causing the pain.
- In some cases, it is thought that the cause may be an over-stretch of soft tissue structures such as ligament (a sprain) or muscle (a strain).
- Other causes may include minor irritations of the discs between two spinal bones (vertebrae), or between the joints (facet joints) at the side of the vertebrae.
- This is not an exhaustive list and other minor problems to structures and tissues of the back may also be the source of pain.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing mechanical back pain. It does not mean everyone with these risk factors will develop symptoms.
- Prolonged standing and awkward lifting – can cause repetitive microtraumas (very slight injuries) and overuse (1).
- People who are overweight or obese – their backs may be physically deconditioned and more susceptible to injury (4).
- Psychosocial work-related stress (3).
- Having had a previous episode of back pain (6).
- Family history of back pain – genetic constitution may play a role (5).
5. Prevalence
Back pain is extremely common. 60% – 80% of people in the UK report back pain at some time in their lives. Chronic (long term) low back pain affects up to 23% of the population worldwide. It is estimated that 24% to 80% of patients with mechanical back pain will have a recurrence after one year (1,2).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like an MRI or ultrasound scan are usually not required, unless more sinister pathology is suspected. There are occasions where further investigations may be appropriate and your physiotherapist can provide you with an effective explanation of how this can help your recovery and rehabilitation.
7. Self-Management
As mentioned, many cases of mechanical back pain will improve with exercise, movement and time. If concerned, it is recommended to have a thorough assessment by an experienced physiotherapist who can advise you on the self-management techniques that may be best suited to you. Your physiotherapist can provide you with an effective explanation as to why you are presenting with your symptoms, and give you knowledge and confidence to effectively manage your symptoms to support your recovery (1).
In general, keeping active is very important rather than resting. Try to keep up with your normal daily activities as best you can; working with some pain and discomfort is completely safe and you will not do any further damage. Just make sure to pace your activities and not do too much at once as this may aggravate your symptoms (1). It is important to understand that resting for prolonged periods of time with back pain can make the pain worse as the spine gets stiffer and weaker.
It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
8. Rehabilitation
Various exercise types all have a positive impact on symptoms, therefore finding activities that you enjoy is a good place to start. Specific, individualised rehabilitation provided by your physiotherapist may include activities to increase your range of movement, strength and function to return to sports, playing with children, or any other activities you love.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing mechanical back pain. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Mechanical Back Pain
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Initially, your physiotherapist may provide you with simple movement or stretching based exercises to ensure we can restore your movement before we move on to the next stage of rehabilitation. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
The next stage may involve strengthening exercises to ensure your muscles, bones, tendons and other structures can tolerate load to meet the demands of your daily activities. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This stage involves further strengthening activities to allow your muscles to tolerate the load for you to return to activities with ease. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
As it is important to keep active with mechanical back pain, it is likely your clinician will advise paced return to sporting activity and daily normal life as soon as you are able. It is important, based on the pain you are experiencing, that you gradually return to sport/normal life by slowly increasing the length of time you exercise for, or the intensity, as the mobility and strength of your back improves with the treatment exercises you are undertaking.
11. Other Treatment Options
Alongside appropriate exercises, sometimes back pain treatment can involve acupuncture and other soft tissue therapies. In a small proportion of patients, based on symptoms arising from neurological assessment, they may be referred on for spinal surgical opinion and sometimes then surgery after this.
12. Links for Further Reading
Chartered Society of Physiotherapy – “Back Pain MythBusters”
https://www.csp.org.uk/system/files/myth_busters_leaflet_-_final.pdf
10 things you need to know about your back | The Chartered Society of Physiotherapy (csp.org.uk)
Back pain – Treatment – NHS (www.nhs.uk)
Mechanical-low-back-pain-00627-v5.pdf (kentcht.nhs.uk)
References
- NICE CKS (2015) Back pain (low) without radiculopathy. (NICE guideline). National Institute for Health and Clinical Excellence.
- Will, J.S., Bury, D.C. and Miller, J.A., (2018). Mechanical low back pain. American family physician, 98(7), 421-428.
- Sterud, T. and Tynes, T., (2013). Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occupational and environmental medicine, 70(5), 296-302.
- Shiri, R., Karppinen, J., Leino-Arjas, P., Solovieva, S. and Viikari-Juntura, E., (2010). The association between obesity and low back pain: a meta-analysis. American journal of epidemiology, 171(2), 135-154.
- Balagué, F., Mannion, A.F., Pellisé, F. and Cedraschi, C., (2012). Non-specific low back pain. The lancet, 379(9814), 482-491.
- Øiestad, B.E., Hilde, G., Tveter, A.T., Peat, G.G., Thomas, M.J., Dunn, K.M. and Grotle, M., (2020). Risk factors for episodes of back pain in emerging adults. A systematic review. European Journal of Pain, 24(1), 19-38.
Other Conditions in
Lower Back, Upper Legs, Orthopaedics, Pain
Spondylolysis
An injury due to a stress fracture through part of a vertebra known as the pars interarticularis of the lumbar vertebrae (lower back).
Spondylolisthesis
A term to describe a slight change in position (usually further forward) of one vertebra relative to the vertebrae below.
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Deep Gluteal/Piriformis Syndrome
A presentation where the sciatic nerve is irritated in the buttock and can cause sciatica symptoms in the leg.
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.