Osteopaths are well known for treating lower backs- but there are a number of red flags that we need to be aware of. These are signs of a potentially dangerous problem that need an urgent referral to a GP or hospital.
What Can’t We Treat?
We can treat non-specific lower back pain, which covers problems involving joints, muscles, and other soft tissues. It doesn’t include:
- Tumours
- Fractures, including those caused by osteoporosis
- Infections
- Nerve problems (although we can treat conditions like sciatica)
- Inflammatory conditions (we may be able to help with the symptoms, just not the cause)
It is helpful for you as a patient to be aware of the signs and symptoms that your back pain needs urgent medical attention.
Cauda Equina Syndrome
When we question a patient about their lower back symptoms, we ask questions to cover any changes to bladder and bowel function. This is because compression of a specific part of the spinal cord can affect continence, and if not surgically decompressed quickly, this can be permanent.
The cauda equina is the lower part of the spinal cord. Unlike the cord further up, the lower part is made of defined nerves and looks like a horse’s tail (cauda equina means horse’s tail in Latin). Due to the areas that these nerves supply, compression here can make you unable to empty your bladder or bowel. Alternatively, it may cause urinary or faecal incontinence. It may also cause “saddle numbness”- numbness in the area where a saddle would touch if you were sitting on it. This might only be noticed when you wipe yourself after going to the loo. Finally, it can cause severe weakness in one or both legs. Any one of these symptoms could be a sign that you should be in hospital.
You can read more about cauda equina syndrome here. Do not hesitate to call 111 if you are unsure whether your symptoms align with this.
Fractures in the Lower Back
You might expect fractures to be hard to miss, but sometimes they can be surprisingly subtle. If you have osteoporosis, you are at higher risk of fractures that require less force than healthy bone would. Sometimes these fractures are only found incidentally later on, for example when undergoing an x-ray or other form of imaging for something else. For other people, pain will be severe, with a sudden onset. The area may also be very tender to touch, and you might find that laying down relieves some of the pain.
Another fracture of note is one that causes spondylolisthesis. This is where one vertebra slips forwards or back on another. Fracture can be a cause of this, if one specific part of the bone is broken. Again, this may be more common with osteoporosis, but it can happen to anyone with enough force. Besides the painful symptoms mentioned above, there may be a notable “step” in the back, where either a bone has slipped forward or is pushing backwards.
Fractures need urgent imaging to determine the extent of the injury, and whether there may be any stability issues or risk to nerves.
If your lower back is free from these symptoms, make an appointment in Wiltshire here
