The Benefits of Physiotherapy for Back Pain
Back pain can be the result of a wide range of conditions relating to the joints, bones, muscles, nerves or connective tissues. Back problems can affect the spine, neck and lower back. Some common back problems causing pain include:
- Upper, middle and lower back pain
- Tingling, weakness and numbness
- Wear and tear of the spine
- Pressure on nerves
- Disc degeneration
- Neck stiffness or pain
According to the Australian Institute of Health and Welfare chronic back problems affect 16% of Australians and contribute to 28% of those with a disability. Chronic back issues can significantly lower a person’s quality of life, affecting their ability to participate in work, social activities and normal daily activities.
How the Back Works
The back is a complex structure providing support to your legs, ribcage, pelvis, arms and skull. Your spine is made up of vertebrae which are a series of bones stacked together forming a column with a slight ‘S’ shape.
Between each vertebra are intervertebral discs which are a spongy type tissue providing cushioning. The intervertebral discs are like shock absorbers and also provide flexibility to the spine. This is all held together with small joints called ‘facet joints’, these are made up of ligaments which hold the spine together.
Support and movement to the spine is provided by a complex layer of muscles. The spinal cord runs through the middle of the vertebral column connecting the brain to the rest of the body.
What is Back Pain?
Back pain can feel like an ache, sharpness, stiffness or tension. There are several causes of back pain such as poor posture, muscle tension from daily activity, an injury or fall, medical conditions or sudden movements. Usually the pain is related to the functioning of the muscles, bones, tendons, discs and ligaments.
Almost everyone will experience some sort of back pain during their life. In fact, approximately 80% of Australians experience back pain at some point. The majority of these people are working age and both men and women are equally affected.
Causes of Back Pain
There are many causes of back pain. Sometimes the cause is not always identifiable as coming from a specific structure, however the majority of back pain originates in the muscles, ligaments or joints and is not due to any serious spinal damage.
Common causes of back pain include:
Muscle Strains and Ligaments Sprains
Around 70% of back pain is due to muscle strain or muscle overactivity and spasm. This usually affects the muscles near the vertebrae and sometimes the muscles a little further from the area of pain. An example of this is tight glutes (buttock muscles) affecting the lower back. The spine consists of muscles, discs, tendons and ligaments which support and protect the spinal cord. Irritation of the muscles, tendons or ligaments of the spine can occur when they are overstretched or strained. This causes these local structures to become sensitised.
Due to the complexity of the spine, injuries such as strains and sprains are common. A strain is an injury to the muscle or tendon. The tendons are strong, fibrous bands that connect the muscles to the bones. A back strain may occur when the muscles and tendons supporting the spine are pulled, overstretched or twisted.
A sprain involves the ligaments. Ligaments are fibrous bands of tissue made up of collagen, connecting two or more bones together to avoid excessive movement at that joint. A sprain occurs when the ligament is torn or overstretched.
When cartilage becomes damaged this may cause osteoarthritis. This can be an additional cause of back pain, particularly if the back also becomes weak or stiff. When arthritis is present this doesn’t mean an individual will necessarily get pain but it can make them more susceptible to episodes of pain. Sometimes wear and tear or arthritis of the spine can lead to structural impingement of the soft tissue causing pain. Usually arthritis of the spine will improve with activity, exercise and manual therapy.
Osteoarthritis in the spine is a breakdown of cartilage in the joints or discs in the lower back and neck. The spine may attempt to improve tolerance to loading by forming growths called osteophytes, or bone spurs. Whilst these are an attempt by the body to improve tolerance to loading they can cause problems. It can cause the spine to stiffen resulting in discomfort from lack of mobility, or the ‘spurs’ can cause pinching of the nerves leading to weakness and numbness.
In the under 45 age bracket osteoarthritis is more common in males, however beyond this age, it becomes more common in females. This disease occurs more often in those who are overweight or have jobs which put repetitive stress on the joints.
Osteoporosis is a common condition which affects over 1 million Australians. This disease causes the bones to become brittle and increases the risk of fractures. Osteoporosis happens when the bones lose mineral density faster than it can be replaced, mainly calcium. This results in a loss of overall bone quality and density.
Osteoporosis increases the likelihood of fractures due to the bones becoming thinner and less dense. Minor falls or knocks can result in a fracture. Any bone can be affected however commonly it is the hips, wrist or spine. Unfortunately, there are usually no symptoms of osteoporosis until a fracture happens, making it a ‘silent disease’.
Osteoporosis in the spine can cause vertebral fractures or compression fractures. Fractures in this area can cause a persistent sharp pain and limited movement. If several fractures occur there can be a loss of height or a change in the curve of the spine.
Sciatica is caused by irritation or compression of the sciatic nerve resulting in discomfort, pain or numbness in the back or leg. The sciatic nerve is a large nerve that begins in the spinal cord. It’s roots pass between the disc spaces and travels from the spine, to the buttocks, back of the thigh and down the leg. This nerve controls the function and sensation to the leg and foot.
Sciatica or sciatic like symptoms can be caused by disc protrusion (part of the disc material pushing onto the nerve) or more commonly and less of a concern, a swelling in the region of the disc which is equally painful. This pressure causes irritation to the nerve and results in referred pain. Sciatica can also be caused by osteoarthritis due to narrowing of the space between discs. Sciatica can cause pain or aching in the back, thigh buttock and calf. It may also cause pins and needles and weak muscles in the legs or feet.
The lower back is an area which takes a lot of punishment from movement. The discs that cushion the vertebrae in this area naturally change with age and loading. The cushioning between the discs can progressively become thinner and whilst this often does not result in pain, for some this can be the result.
Stress-related back pain may not be an obvious cause to most people; however, back pain can be the result of stress for some people. Stress often causes muscles to tighten, particularly the muscles around the shoulders and spine. This muscle tension can result in pain, often lower back pain.
One of the problems with stress-related back pain is that it can cause a cyclical pattern of pain. When you are stressed you experience pain, this affects your mood and activity level. This may impact everyday life and reduce movement causing the muscles to weaken and tighten further, resulting in more pain. As well as this, the pain may cause the person to worry about their condition, causing more stress and more pain. Managing stress and anxiety is a critical part of breaking out of this cycle.
Lack of Exercise
A lack of physical activity is seen as a risk factor for back pain, particularly chronic back pain. Physical inactivity can lead to muscle wasting. This may weaken the support for the spine and place more load on it resulting in pain. Exercise is a proven method that is beneficial for many forms of lower back pain by helping to keep your muscles strong and providing a stable support system for the spine.
One of the most common causes of back pain is poor posture. Sitting in a slouched position places strain and excessive pressure on the muscles, joints and discs which may lead to pain. The effects of poor posture may not be apparent immediately, but over time the strain that poor posture places on the spine may lead to anatomical changes. This may cause constriction of blood vessels and nerves which could provoke back pain.
Studies show that there is a direct link between poor posture and back pain. Poor posture has been linked to computer use, watching television and playing video games. People who spend a lot of time in a slumped sitting position are 50% more likely to suffer from chronic lower back pain.
Overweight and Obesity
People who are overweight or obese generally have a higher risk of suffering from back pain, spinal problems, or joint and muscles issues. Excess weight places additional strain on the spine and increases the risk of injury to the back. Those who are overweight or obese often have problems with lower back pain. This is due to the excess weight in the abdominal region. The pelvis is pulled forward and strains the lower back which results in pain.
Having excess fat around the abdominal area can cause your spinal position to shift it’s centre of gravity to compensate for the weight. This can pull the body forward and place strain on the lower back. This shift may also cause the body to hold poor posture, creating back pain and other back issues.
Lower back pain in sports people can often be caused by poor running techniques. One very common sports injury seen by physiotherapists is poor glute medius activation. This muscle helps to stabilise the pelvis and maintain proper alignment of the spine. It is one of the most important muscles for running.
Running with poor glute medius activation usually causes the runner to have a crouched style of running. This makes it difficult to maintain a normal upright running technique. This can result in the lower back being overworked and leading to pain.
Back pain from running can also be caused by poor posture and weak muscles. Particularly for those who sit down at work for the majority of the day, this may lead to stiffness in the lower back and leg muscles. It is essential to perform proper warming up techniques before running and start slow and with conservative running volumes. Persistent pain may need attention to correct strength deficits before continuing.
Symptoms of Back Pain
Initially back pain may cause mild aching or stiffness. The symptoms may be relieved through light exercise or avoiding standing and sitting for extended periods of time. However, if the symptoms continue and are ignored the pain may become ongoing. There can be many different symptoms associated with back pain, depending on the cause, however you may experience some of the following:
- Pins and needles
- Pain down the leg
- Stiffness in the lower back
- Back pain worsening from bending forward
- Dull ache in the lower back
- Tingling and numbness in the legs
- Hip pain
- Muscle spasms
- Sharp pains
- Muscle weakness
- Difficulties walking or standing up straight
Your symptoms should be assessed by a professional, such as your physiotherapist. Physiotherapy Perth can diagnose your back pain and offer the appropriate treatment and management program.
Treatment for Back Pain
Your physiotherapist will examine your back and locate the cause of the pain. You will be asked to perform a series of movements as far as you are able so they can assess your range of motion. Your physiotherapist may also test your nerves.
Physiotherapy Perth can help to restore movement and reduce pain. Physiotherapists use a wide range of techniques to help you overcome your back pain. Physiotherapist Perth may use a variety of techniques such as exercise therapy, stretching, massage and dry needling. It is generally not advised to rest in bed for long periods of time. Staying active and using medication for pain relief where needed helps the majority of back pain sufferers to recover well.
Preventing Back Pain
Remaining physically active can be one of the most important aspects for preventing back pain. Of course, it depends on the cause of your back pain, which should be determined by a qualified physiotherapist. Exercise can help to keep your muscles strong which provides a good support to the spine. Some ways to lower the risk of back pain include:
- Maintaining good posture
- Strengthening and stretching exercises
- Avoiding heavy lifting and using the proper lifting techniques
- Remain active and eat well
- Lose weight if necessary
Back pain is a common problem that most of us will experience to some degree at some point in our lives. Back pain can interfere with daily life and is a common reason for missed days at work. Often spinal pain affects the lower back, however in most cases it is not serious and can be treated successfully by Physiotherapy Perth. For a full assessment, diagnosis and treatment of your back pain, contact your Back Physiotherapist Perth today.