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Your chiropractor must clearly explain to you what they found during your examination, how they propose to treat you and the benefits or any significant risks associated with your condition and proposed treatment.

Below are some of the questions you may ask your chiropractor:

  • will the treatment hurts?
  • Can someone come in the treatment room with you?
  • Will you be treated in a private room? Most chiropractor treat patients in a private room. However, some chiropractor use an open plan room with several treatment tables and more than one patient are treated at once.
  • Will x-rays be needed? Your chiropractor should only recommend that an x-ray is taken if there is a valid clinical reason for doing so.
  • What if the treatment doesn’t seem to help?
  • What are the costs? Costs vary depending upon the location and the nature of the clinic.
  • How can you make sure that the treatment is safe?
Referred back pain


Back pain, at times, can be due to referred pain from another source. Referred pain is pain perceived at a location other than the site of the painful stimulus/origin. It is the result of a network of interconnecting sensory nerves that supply many different tissues in the human body that the pain may be felt at a location other than the site of the origin.

Below are some of the disease processes that can present with back pain:

  • Pancreatitis. This is a condition characterised by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and the number of hormones. There are two main types: acute pancreatitis and chronic pancreatitis.
  • Kidney stone disease. Also known as nephrolithiasis or urolithiasis, is when a solid piece of material develops in the urinary tract. A kidney stone is formed in the kidney and leave the body in the urine stream. A small stone may pass without causing symptoms. If a stone grows it may cause many symptoms including back pain.
  • Urinary tract infection. Urinary tract infection (UTI) is an infection that affects the part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as kidney infection (pyelonephritis). Symptoms of urinary tract infection include back pain.
  • Abdominal aortic aneurysm. This is a localised enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50 % larger than normal. They usually cause no symptoms, except during rupture. Occasionally, abdominal, back, or leg pain may occur.
Describing Lower Back Pain


Lower back pain is usually described as acute pain or chronic pain.

  • Acute pain comes on suddenly and lasts for few days or weeks and is considered a normal response of the body to injury or tissue damage. The pain gradually subsides as the body heals.
  • Chronic back pain usually defines as lower back pain that lasts over 3 months, this type of pain is usually severe, does not respond to initial treatment and requires thorough medical attention to determine the exact source of the pain.


  • Lumbar herniated disc
  • Degenerative disc disease
  • Facet joint dysfunction
  • Sacroiliac joint dysfunction
  • Spinal stenosis
  • Spondylolisthesis
  • Osteoarthritis
  • Deformity (curvature of the spine scoliosis or kyphosis)
  • Trauma
  • Compression fracture
back pain, Back pain at night


People with nighttime back pain (also called nocturnal back pain), describes the pain not stopping when they lie down. Some people with nocturnal back pain even describe the pain as getting worse when they lie down. For others, the pain doesn’t even start until they lie down.


Among other things, the following can be one or more of the cause of nocturnal back pain:

  • Disc degeneration. Discs are tissue between the vertebrae that function as a type of shock absorber, the discs can degenerate with age
  • Injuries such as sprains or fractures
  • Kidney stones
  • Arthritis
  • Diseases and conditions such as scoliosis, curvature of the spine, spinal stenosis


Nocturnal back pain can be a sign of spinal tumor (one that originates in the spine) or it could be a metastatic tumor (one that results from cancer that started elsewhere in the body and then spread to the spine).

Nocturnal back pain can also be a sign of spinal infection (osteomyelitis and ankylosing spondylitis), a condition that can cause the spine to fuse in a fixed position.



A lower back sprain can happen suddenly or can develop slowly over time from repetitive movements.

Strains occur when a muscle is stretched too far and tears, damaging the muscle itself.

Sprains happen when over-stretching and tearing affect ligaments which connect the bones.

In most cases, it does not matter whether the muscle or ligament is damaged because the symptoms and treatment are the same.

Common causes of strains and sprains include:

  • lifting a heavy object or twisting the spine while lifting
  • sudden movements that place too much stress on the low back, such as a fall
  • poor posture over time
  • sports injuries, especially in sports that involve twisting or large forces in impact
back pain


It is not easy to prevent back pain, but the following 6 tips may help reduce the risk of developing back pain:

  • check your posture when sitting, using computers or tablets and watching television,
  • do regular exercises and back stretches – your doctor or physiotherapist may be able to advise you about exercises suitable for your needs,
  • stay active – doing regular back exercises can help keep your back strong,
  • avoid sitting for long periods,
  • take care when lifting and
  • ensure the mattress on your bed supports you properly.
When is back surgery an option?


Back surgery might be an option if conservative treatments haven’t worked and back pain is persistent and disabling. Back pain is sometimes associated with pain and/or numbness that goes down one or both arms or legs. These symptoms often are caused by compressed nerves in the spine and back surgery more predictably relieves associated pain and/or numbness that goes down one or both arms or legs.

Nerves may become compressed for a variety of reasons, including, disk problems (bulging or ruptured (herniated) disk) and overgrowth of bone which can occur in osteoarthritis of the spine.

Different types of back surgery include:

  • Fusion. Spinal fusion permanently connects two or more bones in the spine. It can relieve pain by adding stability to a spinal fracture.
  • Laminectomy. This procedure involves the removal of the bone overlying the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
  • Discectomy. This procedure involves the removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. Discectomy involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
  • Artificial disks. Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk.
back pain, Lower back pain and spinal arthritis


Non-invasive treatments for low back pain and sciatica

The non-invasive treatments have two types, (a) non-pharmacological intervention and (b) pharmacological intervention.

(a) Non-pharmacological intervention includes:

(1) Self-management – self-management is advice and information tailored to individual needs and capabilities to help themselves self-manage their low back pain.

(2) Exercises – group exercise programme (aerobic, mind-body or a combination of approaches) for people with specific needs or flare-up of low back pain with or without sciatica.

(3) Manual therapies – manual therapy include spinal manipulation, mobilisation or soft tissue techniques such as massage for managing low back pain with or without sciatica, but only as part of a treatment package including exercise.

(b) Pharmacological intervention
Pharmacological intervention includes oral non-steroidal anti-inflammatory drugs (NSAIDs) for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person’s risk factors, including age.

If NSAID is contraindicated or not tolerated or has been ineffective, weak opioids (with or without paracetamol) is usually considered for managing acute low back pain.

Invasive treatments for low back pain and sciatica

Invasive treatments have two types, (a) non-surgical interventions and (b) surgical interventions.

(a) Non-surgical interventions includes:

(1) Radiofrequency denervation

Referral for assessment for radiofrequency denervation for people with chronic low back pain has to be considered when non-surgical treatment has not worked for them and the main source of pain is thought to come from structures supplied by the medial branch nerve and they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent) at the time of referral.

(2) Epidurals

Epidural injections of local anaesthetic and steroid are usually used in people with acute and severe sciatica and tend not to be used in people who have central spinal canal stenosis.

(b) Surgical Interventions

Most performed surgical interventions are spinal decompression, spinal fusion and disc replacement.

Spinal decompression is usually considered for people with sciatica when non-surgical treatment has not improved pain or function and their radiological findings are consistent with sciatic symptoms.

Spinal fusion is not usually offered to people with low back pain unless as part of a randomised controlled trial.

back pain


(1) Avoid bed rest for a long period.
In the few days of a new episode of back pain, avoiding aggravating activities may help to relieve pain. However, staying as active as possible is important in aiding recovery.

(2) Exercise and activity to prevent back pain.
Exercise helps tackle back pain and is also the most effective strategy to prevent future episodes of back pain. No one type of exercise is proven to be more effective than others, so just pick an exercise you enjoy and that you can afford to maintain in the long-term and that fits in with your daily schedule.

(3) Painkillers.
They should only be used in conjunction with other measures such as exercises. Painkillers should be a short-term option as they can bring side effects after long term use.

(4) Surgery is rarely needed.
Most back pains do not require surgery however, in some uncommon back conditions where there is pressure on the nerves that supply the legs and there is incontinence, surgery may be recommended.

(5) You can have back pain without injury.
Many psychological factors, general health lifestyle factors and social factors may cause back pain. At times a combination of these factors may also cause back pain.

  • Psychological factors including fear of not getting better, feeling down and being stressed.
  • General health lifestyle factors like being tired, not getting enough good sleep, not getting enough physical activity.
  • Social factors such as difficult relationships at work or home, low job satisfaction or stressful life events.

(6) If your back pain does not clear up after 6 – 8 weeks make an appointment to see your doctor or a physiotherapist.

coccydynia, Coccyx, coccyx or tailbone pain


In general, coccyx pain is caused by injury. Coccyx injuries are due to direct impact from a fall onto your bottom. The severity of the injury can range from a bruise to a fracture. Most coccyx injuries heal on their own given time and self-management.

Below are some of the advice to help people with coccyx pain:

  • People with coccyx pain are advised to avoid sitting for long periods, so if you can stand during the day, that is recommended. If you must sit, leaning forward will take some of the pressure off your coccyx.
  • Some people find sitting on a “coccyx cushion”, which has a U-Shaped design at the back, helps to avoid weight bearing on the coccyx while sitting.
  • Cold compression can be applied for up to 20 minutes at a time, several times throughout the day.
  • Simple pain killers such as paracetamol and/or ibuprofen can be very effective for helping with pain and swelling, but don’t use them for more than 2 weeks without seeking medical advice.
  • Exercises. It is important to keep your lumbar spine moving normally. The exercises below will help to gently maintain or regain normal movement:
  • (a) Extension Facing Wall. Stand, leaning against a wall with your feet 30 cm (1 foot) from the wall. Puch your stomach and pelvis towards the wall and hold for 5 seconds before returning to the start position. Repeat 2-3 times each hour. (Note – if your stomach touches the wall, move your feet backwards a little for the next stretch.
  • (b) Side Flexion in Standing. Stand with your arms by your side. Slowly slide one hand down the outside of your leg so you feel a stretch. Slowly return to the upright position and repeat to the opposite side. Repeat 2-3 times every hour.