BCA women’s health expert unpacks backpain management for women 

Member of the British Chiropractic Association (BCA), Kathryn Deverson, sat down with us to discuss back pain in women, what causes it, and how to manage it.  

Why do many midlife women suffer from back pain?

Back pain is really common and is something that 60-80% of people will experience within their lifetime, with this being slightly more common in women than men[1]. It is often the case that back pain in women increases significantly with age, particularly post-menopause.    

Lower back pain has also been found to be one of the most common musculoskeletal (MSK) symptoms that women face during menopause. Some studies have shown that an increase in menopausal symptoms correlates to symptoms of chronic back pain. This is because oestrogen helps to maintain tissues that contain collagen, which can be found in intervertebral discs. It then makes sense that as oestrogen levels reduce, the level of lumbar disc degeneration increases, which in turn can lead to increase in lower back pain. 

What are the different types of back pain and what could the cause of these be? What are the solutions?

There is a wide variety of lower back pain, which can be caused by an array of reasons. The first is dysmenorrhea which can cause severe cramping for women during menstruation. It is often the case lower back pain is a common symptom of both primary and secondary dysmenorrhea.  Another form of back pain is pelvic pain, which can often cause radiating pain into the legs and can vary from a mild ache to severe lower back pain. In women, this can be caused by endometriosis, which occurs when tissue similar to the lining of the womb grows in other places, including within the pelvic cavity. However, pelvic pain can be present at any stage of the menstrual cycle.  

Research suggests that 25% of women will experience a vertebral compression fracture in their mid or lower spine, this percentage often increases with age[2]. One of the main causes of this compression fracture is osteoporosis and the hormonal changes decrease the bone density, leaving them vulnerable to fracture.  

One of the more common forms of back pain in women is spondylolisthesis, which is when one of the vertebra slips forward, leading to back, hip or leg pain. This condition can be congenital, meaning it was present at birth. However, women are thought to be more at risk due to childbirth and hysterectomies. It is most common in the lower spine but can occur in the cervical spine as well.  Shoulder pain is again a common symptom in women who are going through menopause. There are many causes for shoulder pain, including rotator cuff tears, bursitis, arthritis; it is a common problem seen in menopausal women. 

Upper back pain is incredibly common and can be as simple as muscle tightness and joint restrictions due to lack of movement which causes pain. Most postural-related conditions affect the neck and upper back, particularly from hunching over phones and laptops in one position for long periods of time.  More serious conditions include ankylosing spondylitis, compression fractures, spinal stenosis and osteoporosis.

Is there anything patients can do at home and who is the best expert to seek help from?  

There are many changes you can make to help ease back pain at home, one of the best things you can do is simply alternating your position throughout the day. Ensure you have good lumbar support as well as adjustable height, and high back support – if you are sitting at a desk more. This can considerably decrease the amount of flare ups and stiffness you will experience.  

One of the best pieces of advice I share with my patients is to simply keep moving throughout the day and stay active – whether it is a walk on your lunch break, a gym session or a couple of simple stretches, all will have a great impact on reducing your back pain. If you find you are still struggling with back pain, seek expert advice from a chiropractor, osteopath, physiotherapist or other healthcare practitioner who can help. The best thing you can do is listen to your body and remember that treatment is never a one shoe fits all approach. As BCA chiropractors, we will always take an evidence, patient-centred approach to our care – and create bespoke care packages for all our patients.

How are NHS GPs supporting MSK issues?

The NHS offer several services for MSK pain, one of the first is blood tests to investigate any hormonal changes or inflammatory-related arthritis, which may be present in your body. You might also find your healthcare practitioner could send you for a DEXA scan, which assesses bone density and risks of osteoporosis. Your healthcare practitioner could also prescribe medication to help relieve symptoms of back pain.   

How are X-rays and MRI’s used to detect MSK issues?

An X-ray can be beneficial to confirm compression fractures, arthritis and ankylosing spondylitis. Alongside this, an MRI is typically done in cases of back pain with associated nerve impingement or neurological symptoms. In most cases of back pain, the results from an MRI will not change the treatment plan you are given, so is often a costly process for minimal gain. There are many self-help resources online, so be sure to check the advice given is by a registered healthcare professional, like a GP, physiotherapist, chiropractor or osteopath.

 

References:

[1] Casiano VE, De NK. Back Pain. InStatPearls [Internet] 2019 Feb 24. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/ (last accessed 21.1.2020)

[2] Greenberg M. 6th ed. New York: Thieme Publishing Group; 2005. Handbook of Neurosurgery. Available from: https://www.academia.edu/40071802/Handbook_of_neurosurgery_Greenberg