In Part 1 of this blog series on back pain we reviewed the three types of low back pain, plus busted some myths about scans and radiology findings. In this post we will review the way physiotherapists can treat back pain, plus the lay out the best advice on what you should do at home or work to make your recovery as quick as possible. In Part 3 of this series we’ll review things that you can do to reduce your risk of future pain episodes.
As we have discussed in Part 1 there are three main types of back pain. Getting a correct diagnosis for your back pain is an important because it guides your initial treatment.
Physiotherapy treatment for this type of back pain focuses initially on relieving your pain and restoring your range of motion. We need to get you back to doing your normal daily activities as fast as possible, allow you to sleep normally, and be able to do your usual work duties. We use a combination of hands-on (manual) treatment together with structured exercise to increase your joint mobility, plus release muscles that are tight or in spasm.
As well as prescribing the right exercises for you, your physio will also clearly explain do’s and don’ts for you at home and work so that you help your back pain to settle as fast as possible. It has been extensively proven through research that staying active within your comfort levels, avoiding bedrest, and returning to your normal work and daily activities as quickly as possible is by far the best way for you to help your back pain resolve. Using basic medications like Panadol, Neurofen or Voltaren can also be very helpful at this stage.
Once your pain is resolving well your physiotherapist can guide you through a progressive exercise program to fully restore your strength, ensure you are moving correctly, and get you confident in returning to the gym or your usual sporting activities. Completing a supervised strength program with an accredited exercise physiologist is the gold-standard later-stage management program for low back pain, especially if you have already had several episodes of pain or are lacking confidence in returning to your full normal gym or exercise activities. If you prefer, Pilates is also an excellent way to exercise following low back pain.
The initial focus for physiotherapy treatment for back pain where a nerve is compressed (or pinched) is to relieve the pressure on the nerve. The degree to which the nerve is pinched or irritated can be gauged by the amount of referred pain that travels down your leg, plus the presence of other neurological symptoms including numbness, pains-and-needles or weakness. Hands-on treatment plus specific exercises are used to relieve these neurological symptoms as quickly as possible, plus medication such as Voltaren can be helpful. You will also be given exercises to do at home by your physio to help you relieve your pain and get moving again.
Once the pressure on your nerve is relieved, the physiotherapy management for radicular or nerve-related low back pain is largely the same as for non-specific low back pain. A combination of hands-on therapy plus structured exercise progression will relieve any remaining pain, restore your movement, and then reactivate your muscles. Staying active within your comfort, returning to work and daily activities as soon as you are able, and avoiding bedrest is strongly shown to be beneficial for this type of back pain.
Once your pain has settled then completing a supervised strength program with one of our physio’s or accredited exercise physiologists will get you fully back to your normal sport, exercise, work and daily activities. Pilates can also be very helpful, if you prefer this style of exercise. Any contributing movement problems that may have contributed to your pain can also be corrected to reduce your chance of future problems.
Serious lumbar (low back) pathology is very rare – present in less than 1% of back pain cases. It includes things like spinal fractures (broken bones), tumors, and some types of infections and inflammatory conditions. During your initial assessment your physio uses specific and effective tools to screen for serious pathology, and they are concerned they will explain their concerns to you and provide you with a referral back to your GP for further investigation.
So, now you know the guidelines for how physiotherapists treat the different types of low back pain. A key take-home message for you is that staying active within comfort, avoiding bedrest, and returning to your normal activity as soon as you are able has clearly been shown to be the best way for you to help yourself recover from back pain. Your physio will give you more guidance on this, plus use hands-on techniques and prescribe the most effective exercises for your specific situation to help you recover as fast as possible.
In the next post in this series on how physiotherapists treat low back pain we’ll review things you can do to reduce your risk of future pain episodes. As always, if you have any questions in the mean time please feel free to contact one of our friendly physio’s to see how they can help!
Low back pain is a very common problem that our physiotherapists treat every day here at Central Performance. There are lots of myths and conflicting advice out there, and this is very confusing and overwhelming for someone looking for treatment during a back pain episode. Although everyone’s presentation is unique and an individual assessment is the foundation of gold-standard treatment, there are some solid research-based guidelines that can really help you understand the process.
In this post we summarise some of the main things you need to know about the 3 different types of low back pain. The next post talks more about how physio’s can treat the pain, and the final one is about reducing the risk of having more problems in the future.
The first thing to know is that low back pain is REALLY common, with approximately 80% of Australians experiencing at least one episode of back pain in their lives. Whilst back pain can be very severe and debilitating, the good news is that the majority of cases of back pain DO NOT involve serious damage and will improve within 6-8 weeks.
Unfortunately there is a very high recurrence rate for back pain, meaning that if you have one episode you are very likely to have another one. Reducing this risk of future pain episodes is one of the major goals of physiotherapy treatment for low back pain. As well as physio you will often get great benefits from seeing an exercise physiologist who can prescribe an effective exercise program for you to reduce your risk of future problems.
Even though most cases of back pain improve within 6-8 weeks, seeing a physiotherapist early can help you in three major ways;
There are two very important findings to keep in mind from extensive back pain research looking at the use of radiology investigations like x-rays, MRI’s and CT’s;
1. The vast majority of back pains DO NOT need radiology investigations. Except in specific circumstances (see below), early imaging is not needed from a diagnostic or treatment planning point of view, and therefore it is generally unhelpful. Importantly, there is a solid body of evidence to show that merely having the scan in the first place can make your pain worse or persist for longer! This is because unrelated findings that often show up on scans can make people worry more about their pain (see the next point).
2. When people have scans for low back pain the report will almost always show “stuff”. A bit of degeneration here, some wear and tear there, a loss of disc height at this level or a bit of a bulge in a disc or two. But research clearly shows that most of this “stuff” is not actually really related to pain! Extensive research repeatedly shows that people who don’t have low back pain also often have disc bulges, disc degeneration, loss of disc height, facet joint degeneration etc… As a clinician I regularly see situations where a client is being treated for one-sided low back pain yet they bring in scans that they have already had done that show more degenerative findings on the other side. These things are usually just normal parts of the aging process, like getting grey hairs or wrinkles!
So, whilst there ARE times when imaging is indicated and the results ARE helpful when taken in the bigger clinical picture, it is important to remember that most back pains DON’T need imaging. Also, if you do have a scan then get your physio or doctor to thoroughly explain the results to you because many of the scary-sounding words are actually not relevant.
Whilst there are several systems around to classify low back pain, the most useful to the general population uses three categories.
1.Non-Specific Low Back Pain: this is by far the most common type of back pain, accounting for approximately 90% of cases. It describes pain that is felt in and around the low back area, and can sometimes extend down in to the legs. The pain can be anything from mild to severe, however there is no numbness, pins-and-needles or muscle weakness. It can be due to structures including joints, discs, muscles and ligaments. There may have been a specific incident to start the pain, eg a heavy lift, or it may just come on for no identifiable reason.
2. Radicular Pain – Commonly Called Sciatica, Nerve Root Pain or a Pinched Nerve: this type accounts for 5-10% of low back pain cases. It occurs when a nerve is compressed as it exits the spine, causing pain running from the back down into the leg. The pain may also be associated with neurological symptoms including numbness, tingling/pins-&-needles, or weakness. Clinical testing of nerve function may show reduced reflexes, power or sensation, and also positive neural tension tests including the straight leg raise (SLR), prone knee bend (PKB) or slump tests. If this nerve compression is present then it is important to begin treatment to relieve the pressure from the nerve as fast as possible. As with non-specific low back pain, radicular back pain can also be either from a specific incident or for no memorable cause.
3. Serious Pathology: this is very rare – less than 1% of low back pain cases are due to serious pathology. It includes things like spinal fractures (broken bones), tumors, and some types of infections and inflammatory conditions. There are specific and effective screening questions and tests that physiotherapists use to identify possible serious pathology and if they are concerned your physio will refer you for further investigation.
Well, that wraps up part one of our series on physiotherapy treatment for low back pain. Next time we look at how physiotherapists treat back pain, and then finally how to reduce your risk of future pain episodes. As always, if you’d like any further information please feel free to contact one of our friendly physio’s at Central Performance!
Low back pain is one of the world’s most common conditions and is a leading causes of disability and work absence worldwide. It affects over 80% of the world population and can result in a significant personal, social and financial burden.1 Low back pain usually settles down within 4-6 weeks but has an 80% chance of reoccurring within 12 months of the initial injury. Exercise therapy is the most common form of treatment for low back pain. It is low cost, easy to access, has a positive biological affect on the body and is recommended in most clinical practice guidelines.2
The Pilates method aims to improve posture and body awareness while building strength. The six basic principle of Pilates includes tightening the ‘powerhouse’ (trunk and gluteal muscles), concentration (cognitive attention), control (postural management), precision (accuracy), flow (smooth transition) and breathing while performing a range of exercises.2
It is a great way to get people moving in a smooth and controlled way. At Central Performance we use the reformer, wunda chair and mat-based exercises in a circuit style approach so that the exercises are varied and fun. These exercises use springs and body weight as resistance and can be adjusted to your ability. Our initial assessment involves a history of your injury and a physical examination to determine your exercise program. Than we get started! Starting on four 1-on-1 sessions to get used to the various exercises on your program. From there the choice is yours. Continue with 1-on-1 sessions or move to our group classes (max 4 people).
But how does this help with low back pain?
Just move! Our backs love movement. The worst thing to do when you have low back pain is to stop moving and stop exercising. Pilates allows you to move and exercise in a nice controlled and monitored way without using heavy weights. It can be a way of progressing your exercise tolerance or to transitions back into gym-based exercise.
I need a stronger core to get rid of my back pain!
This is often a very common perception in today’s society. We are often told to strengthen our core to prevent low back pain. However, if you have had ongoing or episodic low back pain than you may already bracing and overusing your core subconsciously to help ‘protect’ your back. Before strengthening your core it is important to regain normal relaxed movement of the spine. This relaxed spinal movement can fundamentally change the way your back behaves day to day. Pilates is a good way of starting off this process, using controlled movement of the spine before progressing to more progressive strengthening exercises, whether it be at the gym or harder Pilates exercises.
Lower back or “lumbar” disc injuries are a common type of back injury we see here at Central Performance. Our dedicated team of physiotherapists do a fantastic job of reducing pain & restoring the range of motion that can be lost as a result of a disc injury. Extensive research consistently shows that exercise plays a vital role in recovering from an episode of low back pain, but we find that many clients are unsure about how to begin or restart an exercise program. Many are not confident about getting back to even light or moderate exercise, fearing that they may re-injure their back. So today our Exercise Physiologists share a tip on how to avoid re-injury whilst exercising following a low back disc injury:
Many people who exercise with lower back pain do so whilst holding their spine in positions that can increase their pain. Increased muscle tension due to recent pain can change both your resting posture & your movement patterns. For example focusing too much on not bending your spine (remember the old saying of “keep your back straight and bend your knees”?) can mean that your spine stays locked into extension (a deeper hollow in your low back than normal). This increases compression through some spinal joints, and if this is maintained as you go back to the gym this can cause ongoing pain. Alternatively, having hamstrings that are too tight can cause too much flexion (bending forwards) in your low back as you bend down, potentially increasing pressure on your spinal discs and causing more pain.
A golden rule of exercising as you recover from a lower back injury, particularly disc injuries, is to maintain a neutral spine! A neutral spine is the term used for the position of the spine when all three curves of the spine (cervical, thoracic and lumbar) are in proper alignment with each other. It’s the most comfortable, stable position for the spine to be in whilst performing any activity, and you should aim to keep you spine neutral as you get back to exercise.
Keeping a neutral spine is very important whilst exercising, as it distributes your weight evenly throughout the discs and joints in your back, as well as cushioning impact and other forces present throughout exercise. This allows clients with low back disc injuries to progress to performing more complex exercises and movements, which enables them to recover from their injury quicker and get back to doing the things they love!
Initial supervision and instruction on how to achieve and maintain a neutral spinal posture is an important first step to getting back to exercise safely and early following an episode of back pain. Contact us for more information on how our exercise physiologists and physiotherapists can help you with this, and stay tuned for upcoming posts about how to progress your exercises to give you the fastest an most complete recovery possible.