Mechanical Back Pain

Mechanical back pain originates from internal structures including the spine, its connecting joints and its surrounding soft tissues. It is the most common type of back pain and it affects about 8 in 10 people at least once in their lifetime ⁽¹⁾. Although distressing and disabling, it is rarely dangerous and is usually self-limiting (will resolve without treatment). In most cases, there is no clear underlying cause for the pain. This is sometimes referred to as “non-specific”, as it cannot be attributed to a specific structure, pathology or disease ⁽⁵⁾. The spine itself is a strong, resilient structure and not easily damaged. It is commonly accepted that a sprain or strain of a ligament or muscle and/or minor problems with either the disc 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).

• 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.

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).

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.

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.

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.

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.

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)