Back pain in Greenwich

Back pain is usually nothing to worry about, as it is rarely serious. Low back pain and a pulled muscle (strain) are common issues and can often be eased with self-help, such as gentle stretching and anti-inflammatory painkillers.

Common causes of back pain

Some common causes of back pain include:

• Bending or twisting
• Lifting something awkwardly
• Bad posture
• Driving for too long
• Not taking enough breaks
• Lack of exercise

Dr Fariborz Neirami, a consultant in pain medicine and spinal intervention at The Blackheath Hospital, said: “If you have back pain, it’s easier to see someone who looks at back pain in a wide way because the pain can come from the spine, hips, or the pelvis and other places. Coming to the pain clinic for an initial assessment means you can have a thorough assessment and if needed further investigations such as MRI. If there are any ‘red flags’ we can rule them out quickly.”

Most back pain patients at The Blackheath Hospital in Greenwich come with mechanical back pain, impingement syndrome, degenerative disk disease, sciatica, or a slipped disc

Your consultant at The Blackheath Hospital may refer to two main back pain types — acute and chronic back pain. They may also mention neuropathic back pain, which is less common.

Acute back pain

Acute back pain often gets better on its own, with relief for the pain from anti-inflammatories like ibuprofen or a muscle relaxant from your family doctor. You may also find physiotherapy at The Blackheath Hospital to be helpful. Acute back pain lasts for days, weeks or a few months and gradually improves. patients.

There are acute back pain conditions such as osteoporotic vertebral compression fractures, which can be dealt with quickly by minimally invasive procedures to prevent long-standing pain and disability, especially in compromised patients.

Chronic lower back pain

Chronic back pain, often in the lower back, lasts much longer than acute back pain and can be severe and disabling. Your specialist back pain consultant at The Blackheath Hospital can help you to have a smooth journey from your diagnosis to final treatment.

Neuropathic back pain

Neuropathic back pain affects the central nervous system, and the causes include inflammation, disease, and injury to a nerve or several nerves. The pain can be excruciating, with shooting pain radiating down the leg and lower back. It is generally accompanied by pins and needles, weakness and numb legs.

Some medical conditions affect the spine and lead to back pain. We’ve listed some possible spine-related causes of back pain below.

Osteoarthritis of the spine

As we age, the spine’s joints, discs, and bones may degenerate (wear and tear) and become brittle. Also known as spondylosis, osteoarthritis can cause pain and stiffness and is more likely to affect women over 40.

Osteoporosis

Osteoporosis is a painful condition where the density of the bones in the back is lost over time and can result in vertebrae fractures.

Dr Neirami said: “There is a lot we can do at the pain clinic in Greenwich for patients with osteoporosis and compression fracture of the vertebrae. It is a very painful condition that can be helped easily in most patients. One quick and effective treatment is kyphoplasty (balloon vertebroplasty), which provides rapid relief and has excellent results in selected cases.”

Slipped disc

A common reason for seeing a pain consultant, orthopaedic, spinal surgeon or neurosurgeon at Circle Health Group is a slipped disc.

Also known as a prolapsed disc, a herniated disc or a bulging disc, a slipped disc can cause extreme pain. However, it can get better with rest, exercise, stretching and pain relief, so it’s worth trying self-help methods first.

Bulging disc

A disc is like a shock absorber and consists of a soft cushiony nucleus with a tough outer rim between the spine’s vertebrae. If it is compressed all around, part of the outer layer bulges out of the disc wall to cause pain, particularly if it hits a nerve route.

Prolapsed or herniated disc

A prolapsed disc happens when the outer layer of the disc ruptures and part of the soft inner bit protrudes. It can press on a nerve (sciatica) and inflame it, which is why anti-inflammatory painkillers can help. A herniated disc often occurs in the lower spine (lumbar), although it can be felt in the upper back.

Sciatica

A sharp, burning pain that shoots through your buttock and leg may indicate that you have sciatica. It’s caused by a disc pressing on the sciatic nerve because of a bulging or herniated disc. Many back pain treatments at The Blackheath Hospital are to do with sciatica, which is also called radiculopathy.

Dr Neirami said: “Even when a patient comes with sciatica, there is not always a surgical source for it because the pain can mimic other conditions. For example, the piriformis muscle can press on the sciatic nerve and cause piriformis syndrome that is very similar in presentation.”

Sacroiliac joint pain

If you’re feeling pain in your buttocks and lower back, it could be associated with sacroiliitis.

With sacroiliitis, the sacroiliac joints become inflamed. It can feel worse when you are climbing stairs. A specialist spinal consultant should diagnose it, as other diseases could cause it.

Scoliosis

Back pain in and around your spine due to irritation or pressure on the nerves can be caused by scoliosis. In scoliosis, the spine is abnormally curved sideways, often in the shape of an S or C.

Most people will not need surgery, but we can correct scoliosis surgically at The Blackheath Hospital if the pain is severe and steroids or local anaesthetic haven’t helped.

Spinal stenosis

Tingling, weakness, numbness or pain in the legs could be because of spinal stenosis, where narrowing of the spinal column (spinal cord) occurs most often due to wear and tear of the bones and tissues. The Blackheath Hospital has several treatments for spinal stenosis.

Spondylolisthesis

Spondylolisthesis is a spinal condition where one of the bones in the spine (vertebrae) slips out of place. It’s different from a slipped disc. It happens most often in the lower back, but other parts of the spine can also be affected.

Inflammatory spondylosis

In this degenerative condition, also known as ankylosing spondylitis, there is wear and tear in the joints of the spine, as well as the joints and discs. The pain is often worse in the morning but can improve as you move.

Cauda equina syndrome

A rare condition that causes pain in the lower back, sciatica, weakness in both legs, numb genitals, and difficulties controlling the bladder or bowel.

You must seek immediate emergency medical care for this syndrome because it can lead to permanent incontinence and paralysis.

Spinal injury

The Spinal Injuries Association says around 2,500 people annually sustain a spinal cord injury in the UK. Damage to your spine, whether a fracture or dislocation of the vertebrae, can cause tissue to swell and pressurise your spinal nerves and spinal cord. Osteoporosis can also cause broken and fractured bones.

A spinal cord injury requires urgent medical care.

Bone cancer

Like other areas of the body, the bones and bone marrow in the spine can be affected by cancer. A cancerous tumour in another part of the body can also spread to the spine and press against a spinal cord nerve to cause back pain, which can worsen, especially at night.

Most lower back pain is called ‘mechanical’, which means you feel the pain in structural parts of the back like the intervertebral discs, joints, ligaments and muscles when the spine moves.

Pain in the lower back (lumbar) region used to be called lumbago, which means general discomfort and is a non-specific diagnosis. In other words, it could be due to many causes.

Facet joint disease, disc degeneration, ligament injuries, and whiplash can cause lower and middle back problems.

Typical mechanical lower back pain causes

Typical mechanical lower back pain causes may include:

• Repetitive or excessive bending
• Sitting at a desk for too long
• Lifting heavy objects suddenly
• Coughing and sneezing
• Tension and stress
• Pulled muscles and ligaments
• Disc wear and tear

Most back pain does not need surgery. Your family doctor will likely suggest a musculoskeletal (MSK) service or a physiotherapist as your first step.

Dr Neirami said: “Back pain can come from the spine and other elements. Patients can have pelvic problems but complain of back pain. For example, endometriosis and gynaecological conditions can give you back pain.

“My main specialism is the spine, but I get referrals from and refer to general surgeons for hip pain and abdominal pain, orthopaedic surgeons for knee and shoulder pain, and gynaecologists for pelvic pain. Some patients have rheumatological conditions such as rheumatoid arthritis.”

Consultant rheumatologists at The Blackheath Hospital treat disorders where the body’s defence mechanisms attack itself. Common rheumatic diseases also include osteoarthritis and ankylosing spondylitis.

Although not as common as lower back pain, pain in the middle back (thoracic spine) has similar causes.

For example, it could be due to poor posture, age-related osteoarthritis, and medical conditions like compression fracture, indigestion and kidney stones.

Many patients also have upper back pain problems, specifically neck pain, caused by sitting in front of a computer for eight hours and not being fit enough.

Pain between the shoulder blades is also an upper back pain symptom. Causes include arthritis, spinal stenosis, herniated disks and osteoporosis.

A heart attack can also cause upper back pain, chest pain, sweating, shortness of breath, and nausea. Call 999 if you have all these signs.

What organs can cause back pain?

Other organs, such as kidney stones, can cause back pain. Another cause in women could be uterine tissue build-up outside the uterus (endometriosis).

Back pain from other non-spine sources includes infections, tumours and fibromyalgia (chronic pain syndrome).

Dr Neirami said: “The main problems that cause back pain in women are the same as men — spinal and pelvic bone pain. However, some conditions are more prominent in women, like osteoporosis. Other sources, such as endometriosis and gynaecological problems, also relate to women's back and pelvic pain.

“Back pain from the sacroiliac joint, part of the pelvis, is more common in women than men. During and after pregnancy, pelvic pain is common. It may feel like normal back pain, but it’s caused by the sacroiliac joint where the ligament that helps in delivery becomes lax.”

Usually, back pain will improve gradually with self-help and exercise. However, if your back pain is excruciating and doesn’t subside, if it spreads down one or both legs, or causes tingling or numbness in the legs, you should contact your doctor or seek a diagnosis from an expert back pain specialist.

Losing weight unintentionally is another sign that you should see a medical expert.

It is also essential to seek immediate medical care if your back pain causes bowel or bladder incontinence or if you have a fever after an injury or accident.

Anti-inflammatory pain relief such as ibuprofen, a hot or cold pack, and exercises and stretches can relieve acute back pain fast if it starts suddenly. The pain may subside but can continue from a few days to six months.

How to sleep with lower back pain

Dr Neirami said: “Many problems are caused by the mattress not being suitable for you. A firmer mattress is best if you're heavy because you sink into a soft one. You can also try changing your pillow.

“During sleep, it’s best to sleep in the foetal position on your side. Some people sleep on their tummy, and that’s not recommended.”

When you have acute lower back pain, staying as active as possible is vital to prevent stiffness and manage your symptoms. Avoid exercises like running that produce an impact and stress your back.

The following exercises help with general back pain caused by lifestyle and posture. Still, you should check with your doctor, physiotherapist, or back pain consultant at The Blackheath Hospital before exercising.

Is swimming good for back pain?

Swimming is one of the best exercises for back pain if you use the correct technique as it strengthens the core muscles. The water supports your body and relieves stress on the joints.

The front crawl is less likely to put pressure on the lower back than breaststroke, where a typical poor technique is for people to hold their heads too high.

Is Pilates suitable for lower back pain?

The NHS says some evidence suggests that Pilates can help people with lower back pain by relieving tension, improving balance and flexibility, and strengthening your lower back and core.

Our physiotherapists in Greenwich can suggest specific exercises that help with back pain.

Is yoga good for back pain?

Yoga exercises help to strengthen back muscles, improve posture and balance, and make you more comfortable. It’s important to tell your instructor that you have back pain, so they can advise you on which exercises to avoid if any.

Is walking good for lower back pain?

Walking is an easy and accessible way to keep moving, increase your activity and lose weight without putting too much stress on your back. 

The Blackheath Hospital has various back pain specialists who can diagnose and treat your back pain. This includes spinal orthopaedic surgeons, consultants in pain medicine, spinal intervention and pain management, consultant neurosurgeons, consultant neurologists and musculoskeletal and sports physicians.

Dr Neirami said: “A physiotherapist may have ruled out most of the problems before a patient comes to us. The most crucial factor in diagnostics is the patient’s history and a physical examination. You listen and examine the patient; on that foundation, you decide which diagnostic test to start and narrow it down. You rule conditions in or out accordingly.

“If I think it’s facet joint pain, for example, I need to confirm that diagnosis by doing a diagnostic test like a media branch block or facet joint injection to numb the nerve. These are not treatments but confirm that we have found the right joint or joints causing the pain. Then we treat them by applying cervical facet radiofrequency, longer-lasting injections or surgery.”

Diagnostic tests for back pain at The Blackheath Hospital

Many patients come to The Blackheath Hospital from the Circle Health Group MSK service, having already had a magnetic resonance imaging (MRI) scan.

An X-ray will not help diagnose disc bulge, impingement, or sciatica. It can only tell abnormalities of the bone or degeneration, like arthritis.

That’s why MRI is the mainstay diagnosis for issues with the spine. If the MRI can’t be done for medical reasons, another option is a computerised tomography (CT) scan.

The Blackheath Hospital has everything that’s needed to diagnose back pain. Although Dr Neirami’s main referrals will be to consultant orthopaedic surgeons and spinal surgeons, he will also refer to neurosurgeons. The Blackheath Hospital is a neurosurgery centre.

Most patients — more than 90% — come to The Blackheath Hospital in Greenwich with mechanical back pain, such as impingement syndrome and osteoarthritis.

Back pain treatments at the hospital are most often for lower back pain. Some of the main treatments are:

• Epidural injection to provide short-term relief for chronic pain
• Lumbar sympathectomy that blocks the nerves in the lower back
• Facet joint denervation using radiofrequency to kill the nerve

However, we also offer spinal surgery when needed.

Spinal surgery at The Blackheath Hospital

Our highly trained and experienced consultant spinal surgeons offer a wide range of surgeries:

• Cervical discectomy surgery to relieve spinal cord or nerve root pressure
• Lumbar laminectomy and
• lumbar spinal decompression surgery for conditions like lumbar spinal stenosis
• Lumbar spine microsurgery to reduce nerve root decompression
• Minimally invasive spinal surgery to alleviate a range of back pain conditions

Your consultant will be able to talk you through spinal surgery in more detail.

The earlier you begin treatment for your back pain, the quicker you can get back to enjoying life.

If back pain is having a significant impact on your day-to-day life, book a private consultation with us today. You can either book an appointment online or call us on 020 8023 7348 to speak with a team member.

The Blackheath Hospital in London is in the centre of Blackheath village, a stone's throw from the Blackheath train station. It is easily accessible to patients living in Greenwich, Lewisham and Bexley via the M25, A20 and A2.

It is located at 40–42 Lee Terrace, Blackheath, London, SE3 9UD. For instructions on how to get to us by road, train, or bus, click here.

We look forward to welcoming you to The Blackheath Hospital.