Back Pain Treatment and Therapy
The Canadian Chiropractic Association states that 50% of Canadians suffer lower back pain. Statistics Canada reports that four out of five adults will experience at least one episode of back pain at some point in their lives. That means you are more than likely to require back pain treatment and therapy, be it today or in the near future.
If you’re currently experiencing back pain, or exhibiting early signs of its occurrence, you need to consult with a physical therapist right away. The longer you wait, the worse it will get, and the less likely you will be able to return to work, activity, and/or sport.
Back Pain Solutions Available at Our Clinics
Common Forms Of Back Injuries
A muscle strain could have been your injury, causing your joints to be pulled out of their normal position by a tight muscle spasm. Stretching and working on the soft tissue will be more successful than joint manipulations.
“Cracking” your back into place in this case will be a short term fix. You need to have your therapist work on the root cause of the problem to get the the tension off the muscle that was injured to allow the joints to move properly. Then, once the scar tissue or spasm has been corrected, an individualized strengthening plan should be developed for you to get the muscles working and begin rebuilding strength.
Back flexibility is important but strength is critical. Core work and planks are a brilliant way to strengthen and protect your back.
A joint sprain could have been the injury originating in your lumbar, spine, or Sacroiliac Joint ligaments. If this occurs, the area or ligaments may over-tighten or scar down after the sprain. Back muscles will then spasm as a natural protection mechanism to the injured area, indicating that the body is protecting something.
The spasm is useful initially to help the area heal properly and stay protected. However, after a while the spasm can prove to be a concern. If the pain is not settled and the joint motion is not properly restored, the spasm will keep coming back. In this case, you need to confirm that the area is healing properly, or if it is healing too tight or too loose.
You may need mobilizations, stabilization training, or even a brace. Working out the muscle spasms may also be enough to restore joint motion, but other times you may need to very specifically mobilize/manipulate the joints.
Worse, what if the injury mechanism was bad enough and your sprain also involved a fracture? In which case – ongoing protective muscle spasms can be a true sign of warning. Your therapist will be able to evaluate if an Xray is needed and/or work with your doctor to decide. If your back injury warrants an Xray/MRI or CT scan, your physician will ultimately decide and coordinate this imaging to rule out fracture or disc herniation, allowing our therapist to perform manual therapy as indicated and provide rehab direction specific to your case.
A DISC herniation could have been your injury. Your practitioner will be able to assess for this and imaging may also be needed – but not in most cases. If you have certain signs that a disc (spongy stuff between the vertebrae) has herniated (ruptured or blown or slipped or bulged), then your practitioner will decide if it is urgently needing to see a surgeon or if you need to be on a conservative plan.
The pain, spasm and numbness that goes along with a herniated disc can be very uncomfortable and may make you feel like you need urgent surgery. This is common and our clients get very worried and impatient. However, the majority of disc herniations are non-surgical and recover with time (as the disc bulge recedes) or with an appropriate treatment plan to reduce disc pressure.
Again – getting your back looked at will tell you how to proceed. Some disc injuries necessitate urgent care in order to reduce the chance of permanent nerve damage. These usually involve constant unrelenting symptoms and see little change at any point in the day.
Birth defects or Congenital issues may be your issue. If you have back pain that starts early in life and seems to be progressing as you get older, you may have a fracture defect or congential malformation. Some things like scoliosis (curved spine) or spondy (fracture or defect in L4 or L5) called a spondylolysis or spondylolisthesis are things that could cause you problems but are not necessarily a reason why you endure pain for your entire life.
In other words, most people who have scoliosis or a spondy don’t actually have back pain. Therefore – a diagnosis of scoliosis does not mean you will also acquire back pain. Some people have moderate scoliosis and experience no back pain at all. Similarly, some people have poor winter tires – but never get into an accident. So to assume your back pain is a direct result of scoliosis is not a definite answer to your problem.
More than likely you have had the “birth defect” for a long time… (however old you are), but why are you now having pain? It’s possible you could have sprained your back like anyone or injured a muscle and simply needed treatment.
A congenital defect could make you more at risk for injury or pain and it is important to get it assessed and know for sure. A congentital back defect could come in many forms and be a true indication of your pain. Also, having a defect or malformation can indicate a treatment plan can limit pain or potential progression of your injury. There can also be an aggravation or abrupt change to a pre-existing injury (something you were born with), and later in life you can start to feel the effects of it due to natural progression or due to poor movement patterns.
Either way, a thorough assessment aims to find answers and provide you with some “do’s and dont’s” specific to you.
Common Classifications of Back Pain
Axial Pain (or Mechanical Pain)
Commonly characterized by a sharp or dull pain. It can be constant or sporadic. Axial pain is often caused by muscle strain, posture dysfunction, or traumatic injury.
Commonly characterized by a dull and achy pain that tends to move around and vary in levels of intensity. As the name indicates, the pain is often located at some distance from the cause. The cause, is often the result of nerve compression or injury in the abdominal and thoracic organs.
Commonly characterized by a deep and intense pain and may be accompanied by a feeling of numbness and/or weakness. This type of pain is the result of compression, inflammation and/or injury to a spinal nerve root.
A common form of radicular pain is sciatica, which is often the result of conditions such as a herniated disc, spinal stenosis, or spondylolisthesis.
HIPS – Self Check
A – Hip Internal Rotation
1 – Sit upright in a chair with your feet on the floor and knees at a right angle
2 – Keep your knees together and walk your feet apart
3 – You should be able to get your feet at least 24 inches apart to have good hip internal rotation
B – Hip External Rotation
1 – Sit upright in a chair with your feet on the floor and knees at a right angle
2 – As though you were going to put on your socks, cross one leg over the other, place your ankle on the opposite knee.
3 – Let your knee drop towards the floor without force. It should be no higher than 8 inches above the same ankle.
C – Hip External Rotation 2 (Butterfly) Test
1 – Lie on you back with your knees bent and feet on the bed close to your butt.
2 – Keep your feet together but drop your knees apart (Butterfly position)
3 – Your knees should both drop out equally to the side and be at least 24 inches apart, if not, get them assessed to find out what the problem is.
D – Hip Flexion Test 1
1 – Lie Flat on the bed or floor.
2 – Pull one knee to your chest.
3 – If it pinches in the front, that could be the sign of joint capsule inflammation or hip bursitis, get it looked at.
E – Hip Flexion Test 2
1 – Lie Flat on the bed or floor
2 – Pull right knee to your chest and relax the left leg straight out
3 – If the thigh of the left leg lifts off the bed, the hip flexors are tight and can cause extra strain on the hip & low back.
Repeat all “Self-Check Tests” on both sides and compare. Equal measurements are important and any asymmetry can also cause compensations and altered movement patterns.
LOW BACK – Self Check
A – Cobra Test
1 – Lie on your tummy and go into a push up position
2 – Leaving your hips/thighs on the bed – use your arms to push your chest up (like a floppy/saggy push up).
3 – Your low back should be pain free and you should be able to get your chest off the floor while your hips stay down. If not, get your low back assessed today for arthritis or disc disease etc.