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Specialist Orthopaedic Doctors

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Back Pain Injections

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Fluoroscopically Guided Digital X-Ray Injections

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Spinal Manipulation

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Exercise & Rehabilitation Programmes for the Young...

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...and the Not So Young

Prolapsed Disc

What is a Prolapsed Disc?
The disc is the shock absorbing structure that lies between each vertebra, allowing movement, absorbing shock and providing stability to the spine. The disc is made from a jelly-like center (nucleus) surrounded by a hard outer ring. A Prolapsed or Herniated disc occurs when the jelly-like center (nucleus) pushes against its outer ring (annulus). This may initially cause a bulging of the outer annulus of the disc, called a Bulging disc. However if there is enough force or if the outer annulus is very worn or damaged, the nucleus may squeeze all the way through. This is called a Prolapsed or Herniated disc. If the nucleus of the disk bulges out toward the spinal canal, it could put pressure on the sensitive spinal nerves. This can cause pain that radiates down the limb, and you may have associated pins and needles, numbness, shooting pains, and muscle weakness.

In the neck this can cause pain to radiate down the arm this is called Cervical (neck) Radiculopathy (reffered limb pain).

In the lower back this can cause pain to radiate down the leg this is commonly called Sciatica.

People often describe this as a "slipped disc". This is a misleading description, because the disc does not "slip", what actually happens is that the pulpy contents of the disc bulge out pressing on one of the spinal nerves.

What Causes a Prolapsed Disc?
Various things may trigger the inner softer part of the disc to prolapse out through the outer part of the disc. For example, a herniated disk often occurs with lifting, pulling, bending, or twisting movements. In people with a weakness in a disc, this may be sufficient to cause a prolapse. Factors that may increase the risk of developing a prolapsed disc include: a job involving lots of lifting, a job involving lots of sitting (especially driving), weight-bearing sports (weight lifting, etc), smoking and obesity.

What can I do about a Prolapsed Disc in the Lower Back?
With an acute prolapsed disc it may be advisable to rest for a few days until the pain settles, but no longer than this as resting for too long will slow the healing down. It is advisable to take pain relief medication, start with over the counter medications such as paracetamol or ibuprofen (always read the label), however, you may need to visit your GP to get stronger pain relief. Walking and other gentle exercise is often a good way to relieve the pain.

You should seek immediate medical help if your pain is accompanied by:

• Loss of bladder or bowel control
• Numbness around your genitals
• Progressive weakness in your legs
These could be a sign of something more serious like Cauda Equina Syndrome .

What can I do about a Prolapsed Disc in the Neck?
Holding a hot water bottle or heat pack to your neck may help to reduce any pain and muscle spasms. During waking hours check your posture, as this can aggravate the pain and may have caused it in the first place. At night sleep on a low, firm pillow. Avoid using two pillows as this may force your neck to bend unnaturally. Avoid wearing a neck collar – there is no evidence that this will help to heal your neck, and it is better to keep the neck mobile. It is advisable to take pain relief medication, start with over the counter medications such as paracetamol or ibuprofen (always read the label), however, you may need to visit your GP to get stronger pain relief.

You should seek medical help if:

Your symptoms do not recover in 4 weeks
If the arm or hand become progressively numb or weak

Seek immediate medical help if:

You notice your legs getting weak
You have trouble walking
You notice a loss of coordination.

These could be the sign of something more serious like Myelopathy.

How can the Blackberry Clinic Help?
How can the Blackberry Prolapsed discs is one of the most common injury we see here at the Blackberry Clinic. Therefore, at the Blackberry Clinic we understand the issues surrounding prolapsed discs and the impact they can have on a persons quality of life. That is why we pride ourselves on assessing and treating prolapsed discs as quickly and effectively as possible.

Our Musculoskeletal doctors will assess your symptoms, they may order MRI scans and other imaging techniques provide accurate information on disc morphology and can help you decide on your treatment options. We have Osteopaths, Chiropractors and Physiotherapists who are very experienced in managing patients with Prolapsed Discs. They can do manual therapy techniques or acupuncture to ease the pain and provide you with rehabilitation programs to keep the pain at bay. We can also get you started on a bespoke exercise program to suit your age and level of fitness in the Blackberry Gym.

The Musculoskeletal Doctors may suggest you have injection therapy to compliment your therapy. The options include:
• Spinal injections
• Prolotherapy injections
• Epidural injections
• Spinal injections
We can perform these procedures in our state-of-the-art X-ray guided injection theatres on site, for rapid control of your back pain so that you can gain the most out of your rehabilitation.


Lower Back Muscular Strain

What is a Lower Back Muscular Strain?

A lower back muscular strain is when muscle fibers in the big muscles are over strained or torn.

What causes a Lower Back Muscular Strain?

A lower back muscular strain can be caused by a sudden excessive movement, or a prolonged amount of time in a poor position. The pain may come on suddenly or it might start once you have stopped the aggravating activity. The pain will usually be one sided and can be quite severe. Your back may be sore upon touch and the pain will be associated with activities and relieved with rest. It can cause the muscles to go in to a protective spasm, which can leave you feeling stiff and fearful of movement.

What can you do about a Lower Back Muscular Strain?

If you think you have a lower back muscular strain stop the aggravating activity. Avoid doing activities that make the pain worse but keep moving as much as you can within pain free limits.Try to move as normally as possible as abnormal movement patterns, such as tensing up and bracing can make the problem worse. Use ice on the affected area for 10 minutes every hour for the first 48 hours (use a towel between the ice and your skin to prevent ice burn). Then you can use both heat and ice for 10 minutes per hour alternatively. Take some simple over the counter pain relief if needed. If the problem persists or you want help to speed up your rate of recovery the Blackberry Clinic may be able to help.

How can the Blackberry Clinic help?

The Blackberry Clinic has a wide range of therapists, Physiotherapists, Chiropractors, and Osteopaths who are skilled and experienced in diagnosing and treating Lower Back Muscular Strains. They will use a range of manual therapy techniques including, soft tissue (muscles, tendons, ligaments) mobilisation, massage, trigger point therapy (releasing of knotted / tight muscles), myofascial release (connective tissue release), deep tissue massage, acupuncture, stretching and many other techniques.

Importantly they will also give you their expert advice on how to manage the condition and how to get back to your normal activities quickly and safely. They will then educate you on how to change your habits that have contributed to the strain, such as a safe lifting technique or better sitting posture. This will give you the knowledge to take control and stop re-occurrence of the injury, after all prevention is better than cure!

Chronic Pain Management Service

With more than 23 years of experience in the management of musculoskeletal pain, the Blackberry Clinic is ideally equipped to offer a Pain Management Service to patients who have traditionally been treated by a pain clinic in secondary care.

Chronic pain is a complex biopsychosocial problem. A single pathophsyiological explanation is not available for many chronic non-malignant pain states. Up to one-third of chronic pain patients will have no objective findings of organic disease, and conventional treatment solely aimed at relieving pain is unlikely to be appropriate for such patients.

Not all patients need a multi-disciplinary approach, but at the Blackberry Clinic we have these approaches available should it be appropriate for the patient concerned. The Blackberry Pain Management Service is Consultant-led and is a fully integrated multi-disciplinary service providing a patient centred approach to chronic pain and disability. Each patient will receive a customised programme or a combination of approaches appropriate to their condition.

Available treatments include:

  • Consultant anaesthetist/musculoskeletal physician consultations
  • Prescription medication
  • Spinal injection procedures, with fluoroscopic guidance, i.e. epidural/prolotherapy
  • Injections, nerve blocks, radiofrequency neurolysis, facet joint injections, sacroiliac injections, sympathectomy, etc.
  • Transcutaneous electrical nerve stimulation (TENS) and acupuncture
  • Physiotherapy and rehabilitation programmes with exercise orientated programmes based on Pilates and other exercise systems
  • Exercise referral programmes in a fully-equipped gymnasium for functional rehabilitation including general exercise and fitness programmes, as appropriate
  • Psychotherapy, with behavioural approaches such as cognitive behavioural therapy/stress counselling
  • Educational methods for patients and professional colleagues in prevention and early effective management of conditions which may lead to chronic pain
  • Occupational therapy
  • Complementary medicines

It is a basic humanitarian right that pain requires treatment or management, regardless of the cause. At the Blackberry Clinic we believe that although back pain doesn't kill, it 'tortures' and consequently demands adequate service provision.

There is good evidence that chronic pain services themselves are cost-effective - the use of fully integrated pain clinics results in direct savings to the NHS of twice their own cost - and the Blackberry Pain Management Service seeks to provide the highest possible level of care in this field.

"In a Clinical Standards Advisory Group study 11 out of 12 NHS pain clinics could 'not' offer all of the recognised treatments for chronic pain"... but at the Blackberry Clinic, WE CAN!

Causes of Low Back Pain

Back pain is common and affects most people at some point in their life.

Back pain can be triggered by everyday activities at home and at work, or it can develop gradually over time.

backpainBack pain causes include:
• Bending awkwardly
• Lifting, carrying, pushing or pulling incorrectly or loads that are too heavy
• Slouching in chairs
• Standing or bending down for long periods
• Twisting / over-stretching
• Driving for long periods without taking a break
• Overuse of the muscles, usually due to sport or repetitive movements (e.g. from gardening or unusual activity)
• Wear and Tear (osteoarthritis)
• Trauma and sports injuries
• No mechanism- some people just wake up one morning with back pain and have no idea what has caused it.

Back pain can be made worse by:
• Other illnesses or disease
• Being overweight
• Poor core stability and posture
• Smoking
• Long term use of medication that is known to weaken bones, such as corticosteroids
• Low mood, depression and anxiety

Common causes of lower back pain - Click the links below for more information

 The exact underlying cause of lower back pain is often complex and multifaceted. There are lots of different structures in close proximity that are all capable of producing pain, including bones, ligaments, tendons, disks, muscle and nerves. It may be only one of these structures that is causing your pain, however, most chronic (long standing) lower back pain cases are most likely involve a mixture of different structures.

 Here at the Blackberry Clinic our Musculoskeletal Doctors, Physiotherapists, Osteopaths, and Chiropractors are all very highly trained and will use skilled assessment procedures to produce an accurate clinical diagnosis of the underlying cause of your lower back pain. They will decided if you need further investigations, such as X-ray or MRI scan and decide of the most appropriate treatment plan for your specific case. The Blackberry Clinic prides itself on having many types of practitioners under one roof, who will all work together with the common aim of reducing your pain as quickly as possible and preventing re-occurrence.

Other Rarer Causes of Lower Back Pain are:

  • Ankylosing spondylitis- A chronic inflamatory disease. There is no known cure, although treatments and medications are available to reduce symptoms and pain. See National Ankylosing Spondylitis Society for further details.
  • Osteoporotic or fragility fracture- Osteoporosis is caused by low bone density. This is more common in women after the menopause or people who have used high dose steroids for long periods. Diseases such as hypothyroidism can put you more at risk. See National Osteoporosis Society for more details.
  • Rheumatoid arthritis
  • Spondoylolisthesis



      back-pain-2Exercise has been proven to be beneficial in the management of back pain in many ways, from strengthening core muscles to releasing endorphins and improving mood.

      A typical response to experiencing back pain is to take it easy - either staying in bed or at least stopping any activity that is at all strenuous.

      While this approach is understandable and may even be recommended in the short term, when done for more than a day or two it can actually undermine healing. Instead, active forms of back exercises are almost always necessary to rehabilitate the spine and help alleviate back pain.

      When done in a controlled, gradual, and progressive manner, active back exercises distribute nutrients into the disc space and soft tissues in the back to keep the discs, muscles, ligaments and joints healthy. Consequently, a regular routine of low back exercises helps avoid stiffness and weakness, minimises the likelihood of recurrence and reduces the severity and duration of possible future episodes of low back pain.

      Depending upon the patient's specific diagnosis and level of pain, the back pain exercises and rehabilitation programme will be very different, so it is important for patients to see a specialist back pain doctor or therapist trained to diagnose the cause of the pain. The specialist will develop an individualised programme of rehabilitation that will include back exercises, with instructions on using the correct form and technique.

      At the Blackberry Clinic, the Doctors, Physiotherapists and Rehabilitation staff in the fully-equipped gym work together to manage your pain, mobilise your back and strengthen the underlying structures to prevent future recurrences.