Back Pain

Physiotherapy for Back Pain
 

What Causes Back Pain?

The spine is made up 32 vertebrae, each with a disc in between, a joint on either side, a nerve passing out of the spinal column between them, and several muscles and ligaments attaching to them. All of these tissues are capable of producing back pain if they are damaged or overloaded. The shear number of moving parts and interconnection of tissues means the back is the most complex area of the body, and is why back pain is the thing that we spend most time treating at The Physiotherapy Place.

Back pain can be felt in many ways:

  • sharp pain if there is a pulled muscle

  • shooting pain if there is a pinched nerve

  • dull and achey pain if there is chronic muscle tightness or degenerative changes in the discs and joints.

In most cases there is an underlying cause of back pain and this is often to do with lifestyle or posture. For example, a slipped disc might occur when bending to lift something up, but more often than not the disc will have been weakened over the preceding weeks or months from poor posture whilst sitting or driving.

Acute vs Chronic Back Pain

Acute back pain:

  • refers to an episode of back pain that happens suddenly and lasts anywhere up to 6-8 weeks

  • might include a slipped disc when bending to lift something up, or muscle spasm from repeated bending in the garden

  • there is inflammation initially and it can be very sore to move, but as the damaged tissue heals the muscles begin to relax and movement is restored

  • with the correct management acute back pain will settle and you will return to normal

Chronic back pain:

  • refers to back pain that has been there for longer than 8 weeks

  • this can be an acute back pain problem that hasn’t cleared up so has become chronic, or it can be back pain that has gradually crept up for no apparent reason but then lingers on

  • usually manifests as a lot of stiffness, particularly after rest, or pain that comes on with specific postures such as sitting at a desk or standing for a while

  • some of the structures in the back such as the joints, discs, or muscles may have become overloaded and reached a point where they can’t function properly and this can result in constant pain

Why do I have constant pain in my back?

Constant back pain is normally due to a combination of issues with the vertebrae, nerves and muscles around the spine. Poor posture results in a build up of stress on the spine that can lead to pressure on the discs and joints of the vertebrae. The result is that the discs get compressed, the joints have more stress through them and the spaces that the nerves travel through become narrowed. This leads to nerves becoming irritated and that causes tightness and spasm of the muscles around the spine which will create more compression of the vertebrae. A viscous cycle of vertebral compression, nerve irritation and muscle tightness is then started which is usually the reason for constant back pain.

Is chronic back pain curable?

A healthy back with good flexibility and strong muscles shouldn’t normally give you pain, so if you are one of the people who think that they just have to live with a ‘bad back’, more often than not there is something that can be done about it. The key is in the diagnosis. A good example is that a common symptom of chronic back pain is muscle ache and tightness but we need to know what exactly has caused the muscle to tighten in the first place in order to sort it. Muscles don’t tighten up for no reason so just treating the symptom i.e. massaging or stretching the muscle will not tend to provide lasting relief. There will usually be a stiff joint or an irritated nerve that is causing the muscle to tighten so for effective long-term relief, this must be treated as well as the muscle itself.

What is the best treatment for chronic back pain?

Because there are usually several structures involved in long-term back pain - discs, joints, nerves, muscles - there isn’t a one-size-fits-all approach to treating it, which is why just doing some exercises alone isn’t usually enough. Each of these structures needs to be treated appropriately in order for the problem to fully resolve.

Some of the treatments I commonly use are:

  • Manual therapy to get the joints in the spine moving more freely and to take the pressure off the discs.

  • Acupuncture or Gunn IMS to stimulate the nerves in order to get them settled down. This will help reduce muscle spasm.

  • Further relaxation of the muscle can be achieved with sports massage.

  • Specific exercise program to stretch and strengthen the components of the spine so that the injury doesn’t reoccur. Here you can find some of my favourite stretches for the upper back and lower back.

Ultimately there are many types of treatment that are used to effectively treat back pain. No two cases of back pain are the same which is why it is important to establish the main causes of your problem, and then treat these accordingly. In almost all cases, back problems can be restored to a level where you can manage them with exercise and there is no need for long-term painkillers.