Articles: Dealing with Back Pain

Physiotherapy Approach to Treating Back Pain

Backs are busy.

Your back is working whether you are lifting your children, digging in the garden, playing hockey, driving your car, brushing your teeth or sitting watching television. It is not surprising that when your back starts hurting, it has a major impact on your life.
If you are suffering back pain, you are not alone. At least 80% of Canadians have a significant episode of back pain at some time in their lives. And it is only second to the common cold as a cause of missed time at work.

Where does back pain come from?

The back is a complex structure. It relies on the intricate interplay of bones, joints, muscles, and nerves all working in harmony to allow us to move efficiently in a pain-free way.

Back pain can arise from damage to a single component or more commonly from injuries to a combination of several parts. Damage can result from a single episode of trauma or from years of improper wear and tear on our backs. Pain can be felt localized to the back or it can shoot into the leg. Most of the time, leg pain represents pain from back irritation, which sends “crossed signals” into the leg. This is called referred pain. However, if the Sciatic nerve (one of the nerves arising from the back) is irritated, it may cause leg pain without back pain. This is often a burning pain felt at the back or side of the leg and may shoot all the way into the foot. There may be an associated numbness or a “pins and needles” sensation. This is called Sciatica.

How do you know what’s wrong with my back?

Physiotherapy treatment at The Headache & Pain Relief Centre begins with an in-depth assessment of your back. This includes assessing the spinal mobility, the power of your core (abdominal) muscles and evaluating the activity of your posture muscles. In addition, your posture will be analyzed both statically and dynamically, simulating real-life activities. This allows us to understand where the pain is coming from and what is needed to correct it.

Once the assessment is complete, your physiotherapist will develop an individualized treatment plan to get you feeling better fast. This plan may include the use of modalities such as laser, ultrasound, acupuncture and/or TENS. Most treatment plans include hands-on treatment featuring such techniques as spinal mobilisation and strain-counter strain. This is part of the Headache & Pain Relief Centre difference that you may not see at other Rehab clinics.

Once your pain is under control and your spinal motion is restored, the next phase of recovery begins. Your therapist will give you specific exercises to stretch and strengthen your back. Often after an injury the back muscles stay in spasm, even if the original injury they were reacting to has resolved. Teaching them to relax is crucial to preventing them from becoming contracted and a source of ongoing, chronic pain. The exercise program designed specifically for you will work your postural muscles. These include the core muscles in your abdomen and the long, strong muscles running up and down your spine. This group of muscles plays a vital role in keeping your back healthy. Following an injury they need to be re-educated to work in harmony to prevent further spinal injury.

What happens next?

You will also receive education on lifestyle adjustments, such as ergonomics in the work place and correcting your posture. Many people are unaware that their sitting position while at the computer can be detrimental to their back. This also applies to the way they pick up their children’s toys off the floor or how they shovel snow. All these activities are part of our daily routine and require strength, flexibility and endurance of our postural spinal muscles. Improper posture and poor co-ordination of our backs is what sets us up for damage when we lift a heavy bag of groceries or suffer a slip and fall. Maintaining proper postural awareness is another crucial part to recovery, and will insure that you maintain good back health for the rest of your life.

Massage Therapy and Back Pain

My approach to treating back pain starts with a good history. This will help me decide if your back pain is acute (recent onset and due to a specific event such as lifting something heavy or being involved in a car accident), or chronic (usually ongoing pain from an injury months or years ago). Acute pain is often sharp and chronic pain can be dull or achy, but many variations exist. Many people have low-grade, ongoing chronic back pain with acute flare-ups.

This is an important distinction, as each of these conditions need different treatment. The focus on a fresh, acute injury is first to relieve the pain, let the inflammation settle down, and get you back to your full active life as soon as possible. Chronic pain is different. Ongoing pain may not be that severe at any one time, but starts to take over your life. Chronic pain affects the way your brain and body function on a daily basis. Chronic pain can affect your concentration, memory and mood, even leading to depression. Your body develops a series of compensatory muscle firing patterns that can cause muscle overuse and injury (and more pain) far away from the original injury. For example, many people with chronic back pain develop leg, neck and shoulder pains over time.

Massage therapy can help relieve the pain by loosening muscles, relaxing trigger points, reducing stress on your joints, decreasing nerve firing and calming the pain detectors on the surface of your skin. (Trigger points are those concentrated, tender knots of muscles that can shoot pain to different locations in the body when pressed.) A good massage therapy session can decrease muscle tone and shut down lactic acid release, which can immediately provide significant pain relief. Repeated sessions help to break up scar tissue, allowing the muscles to realign themselves into a healthier pattern of response to everyday movements. This leads to relief of acute and chronic pain, and more importantly breaks the cycle of overuse and re-injury.

After your pain starts to settle, the next important stage of recovery and rehabilitation begins. I will give you a series of stretching and strengthening exercises to help maintain the muscle tissue length, decrease tightness
and regain strength in your injured muscles. Many of these exercises will focus on posture and the core muscles that influence your posture.

Poor posture contributes to back pain. When posture is poor, the usual weight-bearing bones and muscles can’t do their job. That stress is then put through different muscles that compensate by becoming tighter and causing restriction in movement and eventually pain and discomfort. Postural exercises can be given to help fix muscle imbalances and help to correct poor posture.

After this, a few more sessions of massage therapy can provide the stress relief you will need to move forward at your best, ready for any challenge!