“It’s my back”

Some people experience back pain as a mild annoyance that they can generally live with. While for others back pain can be life changing in terms of the impact it can have on one’s occupation, recreational activities, social life, family life and mental health status.

Common Treatments for Back Pain

Below you will find information on some of the more common treatment options for back pain. The decision to use one, some, all or none of these interventions is guided by a careful assessment of the relevant scientific literature and an analysis of your specific circumstances and case history.

Education & Problem Framing

Arguably the most important component of any treatment program for back pain is the explanatory narrative offered by the treatment provider. As a treating Physio, it’s my job to ensure that you have the correct understanding of your back pain’s cause and prognosis. This is important, because one of the strong predictors of a progression from acute, manageable back pain to chronic, unmanageable back pain is a skewed or erroneous understanding of the causes of back pain and a belief that one’s symptoms cannot improve.

Proper framing of a back pain problem starts with a few facts:

 

Read More…

Activity Modification
Graded Strength & Conditioning
Joint Mobilisation
Joint (thrust) Manipulation
Remedial Massage
Sports Massage
Core Strengthening
Trigger Point Therapy

 

Types of Back Pain – Acute / Recent onset

An acute episode of low back pain can be extremely disabling. It’s also pretty scary if you’ve never experienced it before. Typically though, the “bark” of acute back pain is much worse than its “bite”. In other words, acute back pain, even the really painful episodes rarely reflects serious or long lasting injury to the spine. Although knowing this won’t necessarily make this type of back pain hurt any less right now… it is useful to know that this sort of pain tends to follow a certain recovery trajectory and resolve in a fairly predictable time frame. Very intense pain is not necessarily a sign of very serious injury. The best way to work out whether or not your back pain is more “bark” than “bite” is to have your symptoms assessed against other factors such as your recent activities, occupation, age, fitness level etc. The following three videos reiterate these ideas.

Explaining acute back pain

Acute back pain from a traumatic event

Acute back pain and sinister pathology

 

Types of Back Pain – Longstanding / Chronic)

Longstanding back pain is tough to deal with. In extreme cases, treatment can become more about managing pain than resolving it. The bottom line unfortunately, is that no one knows for sure why some people have back pain that becomes chronic. However, researchers are beginning to put together pieces of the puzzle. We do now know for sure that chronic back pain is more complex that the degree of structural damage or wear and tear in the spine. So a nasty looking MRI or x-ray scan doesn’t necessarily explain chronic back pain.

Managing chronic low back pain

The management and treatment of chronic low back pain requires a comprehensive analysis of your case history. A chronic pain state emerges from the influence of many many factors. You can learn more about how pain works in this series of posts. The principle ideas discussed in the linked posts apply to cases of chronic low back pain. In short, chronic pain states are driven by abnormally heightened nerve ending and nerve pathway sensitivity. The challenge is to come to a judgment about the most likely driver of that heightened sensitivity.

SIMPLIFIED FLOWCHART

The diagram above illustrates the relationships between those factors that can lead to a chronically heightened state of nerve ending and nerve pathway sensitivity. In my experience, chronic low back pain is very often maintained by an erroneous understanding that wear and tear of spinal structures is a cause of chronic low back pain. This erroneous understanding leads to a cycle of protective behaviours and coping strategies that ultimately lead to more stiffness, pain and disability. Frequently, treatment comprising education with regards to how pain works, combined with manual therapy to reduce muscular guarding results in resolution or significant reduction of chronic back pain, and a significant increase in ability to participate in recreational and occupational activities. If you have chronic low back pain, and your understanding is that it can’t be helped because it is solely driven by structural damage to your spine, give us a call on  02 9665 9667. Chronic low back pain is always more complex than the degree of wear and tear in your discs or other structures. It’s possible to reduce the sensitivity of your nerve pathways and nerve endings, so it stands to reason that it is possible for your back to reduce or resolve.

 

Common Back Pain Diagnoses

You may have already received a formal diagnosis for your back pain by a Health Professional or Doctor. Or perhaps you’ve been googling about in an attempt to find a solution to your back pain. We’ve included a list of common diagnoses that are often provided to patients to explain their back pain. It can be very helpful to place these structural diagnoses within the broader context of the physiology from which back pain emerges.

Herniated / Bulging Disc / Annular Tear

A herniated or bulging disc would by far be the most common answer I receive when I ask patients the question- “what do you understand to be the cause of your pain?” When we are discussing disc related neck or back pain, it is really important that we place the herniated or bulging disc within the broader physiological context from which symptoms emerge. Put simply, the presence of a disc bulge or disc herniation is only part of the story of neck or back pain. It may be a big part of the story, or a small part of story… as time goes by, the bulging or herniated disc should become a smaller part of the story.

Read more…

Compressed / Pinched Nerveroot

This diagnosis often goes hand in hand with a diagnosis of a bulging or herniated disc. Very often patients will explain to me that their pain is a product of a disc bulge squashing a nerve root in their spine, with their pain spreading down the leg or arm. It is quite common for an MRI study to reveal contact between a bulging / herniated disc and a spinal nerveroot. But again, these findings also turn up in MRI results of people with no pain. So I think it is worth reiterating the concept of nerve sensitivity.

Read more…

Sciatica

Sciatica is a diagnostic term that was coined in the 1980s to describe the classical presentation of pain running down the back of the leg along the path of the sciatic nerve. It is not a particularly useful diagnostic label. Typically, someone with this diagnostic label will have an MRI showing compression of the S1 spinal nerveroot.

As we have already discussed above however, the compression of a spinal nerveroot is only part of the “i have a pinched nerve in my back” story. Sciatica is essentially a label used to describe the most common location at which a spinal nerve becomes symptomatic- that being the L5/S1 segment. Like any clinical scenario in which there is spinal pain, and pain referred along the path of a particular nerve, we need to ensure that the treatment plan includes appropriate education about how pain works, combined with appropriate medication, manual therapy and a graded return to pre-injury or pre-pain activities.

Read more…

Scoliosis

Scoliosis was originally a Greek word meaning curved or bent. Today it is a word used to describe the most common type of spinal curvature. Scoliosis is simply a descriptive term, like headache- it is not a precise diagnosis. In other words, if you have had some imaging like an x-ray, or some other form of assessment that indicates that you have a spine that curves laterally, the next step is to work out why your spine is curved in such a manner.

There is some useful information about the various “types” of scoliosis on www.scoliosis-australia.org.

Small lateral curves in the spine a common and are of no particular consequence to an individual. For most people, a mild scoliosis is not something that warrants any specific treatment. We (people in general) are not perfectly symmetrical beings. We are capable of adapting to a mild scoliosis and performing our preferred occupational and recreational activities over a lifetime.

There is however, a smaller group of the population who develop more pronounced or prominent curves in their spines. And since every pronounced or severe case of scoliosis starts off at some point as a mild case, it does make sense to take measures to identify those who might be at a higher risk, as this will provide the best opportunity to commence effective treatment.

Read More…

Spondylitis, Spondylolysis, Spondylolisthesis, Anklylosing Spondylitis

Weak Core

The concept of “core” strength and it’s role in back pain and rehabilitative exercise programs emerged from research carried out in the early 1990s. The popularity of core stability training soared as this research made its way into the practice patterns of clinicians and trainers throughout the 1990s and into the 2000s. The message that has long since been propagated is two fold:

  1. that a weak core predisposes one to lower back injury and pain
  2. that the resolution of back pain is contingent upon strengthening of the core

Read More…

 

 

Call us today to chat about your back pain. 9665 9667. Or book an appointment online.

booking

 

 

 

 

 

1,784 total views, 3 views today