Physiotherapy for back pain as a treatment modality is not new. Back pain is a complicated condition with many causes. A staggering 80% of adults will experience back pain at some point in their lives.
Physios are experts in diagnosing the cause of back pain and providing treatment tailor made to your particular problem. Generally this involves soft tissue massage, joint mobilizations, advice on postural correction and exercises to get you back to your normal activities and enjoying them again. Here is some information on several common conditions but remember –
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The intervertebral disc is a soft, rubbery pad that allows bending and straightening of the spine and also provides a shock absorbing effect. The disc consists of a gel like substance in its centre (the nucleus) surrounded by a gristle like cartilage (annulus). A disc herniation or rupture occurs when the inner nucleus pushes out into the annulus. This results in the annulus being pushed into the spinal canal and putting pressure on the nerve roots. The discs have a high water content in the young. As we age the water content decreases resulting in the discs shrinking and the vertebrae coming closer together, the elasticity of the disc also decreases. These together weaken the disc and make it more susceptible to rupture.
How this condition develops
1. Sudden increase in pressure in the discs eg by Incorrect lifting techniques
2. Wear & tear
3. Poor posture
4. Excessive weight can squeeze the softer inner nucleus into the fibrous annulus
The presence of the disc in the spinal canal puts pressure on the nerve roots resulting in pain. In some cases the outer fibrous annulus can tear. In serious cases pieces of the disc can break off and become lodged in the spinal column where they can cause damage to the nerves controlling the bowel and bladder.
- Sciatica = a set of symptoms including pain caused by general compression or irritation of one of five spinal nerve roots of each sciatic nerve or by compression or irritation of the left, right or both sciatic nerves
- Shooting pain from the back, down the buttocks that can extend down the back of the thigh and leg to the foot
Pins and needles and/or numbness in the buttocks/thigh/leg/foot
- Weakness in the leg
- There will also be local burning back pain and spasm of the muscles in the low back area.
In most cases pain and sciatic symptoms are aggravated by bending of the spine (e.g. sitting, bending to the floor etc.).
Physiotherapy for Back Pain – Treatment
In most cases a disc herniation can be treated conservatively of which physiotherapy plays a major role.
Initially physiotherapy will aim to reduce pain and inflammation. Once the pain has settled treatment would focus on strengthening of the muscular corset that provides a support system to the lower back and correction of any other muscle imbalances i.e. tight or weak muscles. Your physiotherapist will also educate you about such things as correct posture and lifting techniques etc. to prevent reccurrence.
In some cases pain does not settle and surgery is required to take pressure of the spinal nerve. This is followed by physiotherapy to return your back to normal function (strength and mobility).
Pain in the lower back can restrict your activity and reduce your work capacity and quality of enjoyment of everyday living.
Common causes of low back pain include
1. Strain/sprain – The muscles in the low back provide the strength and power required for standing, walking and lifting. A strain of the muscle can occur when the muscle is weak or overworked. The ligaments of the low back interconnect the five vertebral bones and provide support/stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament which has become stiff or weak through poor conditioning or overuse.
The normal effects of ageing and “wear and tear” can result in:
• Osteoporosis or weakness of bone
• Decreased elasticity and strength of ligaments and muscles
• Disc degeneration – loss of shock absorbing ability of the discs
• Arthritic changes e.g. formation of bony spurs, inflammation of joints
Although wear and tear will occur in everyone only some people will present with back pain. The ageing process does however predispose the individual to injury with minimal trauma (e.g. with osteoporosis crush fractures of the vertebrae can occur with normal daily activities). Because the ligaments and muscles are weaker and less elastic they are more easily injured (e.g. when lifting).
3. Hypomobility and hypermobility – In general hypomobility (stiffness) of one more intervertebral segments is often associated with low back pain. Occasionally there can be increased mobility of the lumbar spine e.g. in someone who is generally mobile in their other joints. If however only one level is hypermobile this would indicate lumbar instability.
• Localized pain to the low back area that can be unilateral or bilateral depending on what is injured
• Movement of the low back may be limited by pain – the direction of limitation will depend on the structures involved
• Tenderness of the involved vertebrae
• Muscle tightness or spasm with tenderness
Diagnosis and treatment
In most of the above cases the initial aim is to reduce pain and inflammation. Once the initial pain has settled your physiotherapist will aim to restore full function of the low back. You will receive exercises to mobilise and/or strengthen your back and your Physio will also educate you on correct posture and preventative measures to reduce the reccurrence of low back pain (e.g. correct lifting techniques, walking aids to prevent falls in the elderly).