Physiotherapy for back pain

Physiotherapy for back pain

Reviewed By

Dr. Gargi Naha (M.Pth (Musculoskeletal))

Back pain is one of the most prevalent forms of pain experienced by individuals of almost all ages. It is one of the leading causes of disability worldwide affecting about 18 out of 24 individuals below 45 years of age.

However, low back pain is not a cause in itself. It is one of the symptoms of the underlying cause of back pain. It could be related to the muscles, spine, ligaments surrounding and supporting the back as well as the disc in between the vertebrae.

It can present with different kinds of pain ranging from sharp shooting pain in a specific region of the back to dull aching pain in a generalized area.

Anatomy of the Back

The back is divided into four regions being- cervical, thoracic, lumbar and sacral region.

The cervical region includes the neck region, the thoracic region is known as the upper back region, the lumbar region as the mid-back region and the sacral region is known as the low back or buttocks regions.

The back is made up of the vertebrae, the spinal cord, muscles, ligaments and discs in between the vertebrae.

  • The vertebrae

They are supporting bony structures that surround and protect the spinal cord. Different regions of the spine have different shapes and sizes of vertebrae.

  • The spinal cord

It is a collection of nerves and vascular structures that run through the entire length of the spine. It is responsible for sensations and transmitting impulses through the body.

  • The muscles

It supports and helps in the movement of the back in all planes. Bending forward, backward, turning sideways and twisting are actions that require muscles to participate.

  • The intervertebral discs

They are cushioned pads that are present in between the vertebrae. They absorb shock and prevent friction in between the vertebrae.

  • The Ligaments

The tendons are short bands of tissue that hold the vertebrae and discs in place. They have elastic properties. They even help in maintaining the structural integrity of the spine during movement.

Risk Factors of Back Pain

Some people are more likely to experience low back pain than others.

  • Age

People over 35 years of age tend to experience more frequent episodes of back pain. The normal wear and tear of the disc with age is the commonest cause of back pain in the elderly and aged population.

  • Occupation and Activity levels

People who generally lead an active lifestyle are less likely to experience back pain. This is due to the loss of muscle and ligaments properties of the back due to lack of movement. Employees sitting in front of the desktop, without any breaks in an awkward posture are prone to back pain. Heavy lifting and bending jobs also cause back pain.

  • Weight

According to a journal published in National Library of Medicine (US), Obese or overweight individuals are more likely to experience back pain. This is primarily due to the additional weight on the spine. Any sudden jerky movement or activity can easily produce back pain symptoms in the individual.

  • Lifestyle habits

A sedentary lifestyle is a common risk factors for back pain.

  • Other causes

Medical ailments like osteoarthritis, spine tumors, kidney stones, tuberculosis, depression, anxiety, and cancer can expose an individual to back pain.

Symptoms of Back Pain

Back pain would itself sometimes occur as pain in any one or more than one region of the back. However, other symptoms like stiffness, muscle spasms and different types of pain can also be seen along with back pain.

  • Stiffness is generally experienced when a person is finding it difficult to move or bend the back. They might feel the need to stretch or loosen up before doing any movement to lessen the stiffened back. A decrease in the overall range of motion may be seen.

  • Pain in the back may represent a generalized pain in a region of the back. Dull aching pain is usually due to muscle causes. Sharp shooting or pricking pain due to nerve pain. Pain travelling up to either one or both the arms or legs is called radicular pain.

  • Postural and muscle problems also cause back pain. An awkward posture while sitting or a posture adapted over the years like a slouched back, a forward neck can cause postural back pain. A muscle spasm can restrict the movement of the individual completely.

Back pain is generally categorized into acute, sub-acute and chronic pain. This categorization is based on the duration of pain. Back pain for less than six weeks can be termed acute pain. Pain experienced over the last six to twelve weeks can be categorized as sub-acute pain. Whereas, the pain felt for more than twelve weeks is chronic pain.

All these categories of pain demand a different set of care and treatment from a professional.

Types of Back Pain

For the sake of better understanding the symptoms, causes and treatment of each kind of back pain. Let us further divide back pain into:

  1. Mechanical back pain

  2. Back pain with radiculopathy,

  3. Discogenic Back pain, and

  4. Spinal Stenosis

However, there are many other types of back pain due to the varied underlying causes of back pain. A specialist will be able to diagnose and guide you the best on it.

1. MECHANICAL BACK PAIN

Mechanical back pain is one of the commonest kinds of back pain. It occurs when there is a disturbance or problems associated with the intervertebral discs, ligaments, vertebrae or any other surrounding structures of the spine.

Excessive stress or pressure for a prolonged period on structures surrounding the spine causes mechanical back pain.

Load on any part of the spine for a prolonged period causes stress and irritation in that region, resulting in deformity or shifting of the structures to an abnormal state.

Mechanical back pain can occur due to sudden trauma to the back or due to continued exposure to faulty postures, load and stress. This causes the surrounding muscles and ligaments to develop reactive spasms and pain.

Prolonged standing, sleeping, and sitting can aggravate the pain. Some people even experience a sudden flare-up pain sign that restricts all types of movement in the back.

How to treat mechanical back pain?

  • Non-surgical treatment is advised commonly in mechanical back pain. Generally, a physiotherapist is the best specialist to assess, guide and treat back pain.

  • Severe back pain with flare-ups is usually seen reducing after bed rest for more than 48 hours.

  • Ice and heat application is also advised to relieve pain experienced in mechanical back pain. Generally, applying heat for 20 minutes followed by 20 minutes of ice application is advised two or three times a day. This reduces the muscle spasm and inflammation, ultimately helping in pain reduction.

  • Physiotherapy is recommended for all types of back pain. The physiotherapist will not only work on reducing pain and spasm but even work on correcting your posture, promoting strength and flexibility in your spine. An active physical therapy exercise program can benefit you in the long term, preventing any kind of pain or difficulty in the future. The therapist would teach you exercises without any equipment which will help in reducing pain, and spasms and facilitate proper movement in a normal postural alignment.

2. BACK PAIN WITH RADICULOPATHY

Radiculopathy refers to pain that originates from one end of a nerve and travels along the entire course of the nerve. For example, pain originating from the lumbar or lower back region of the spine to either one of the legs is known as lumbar radiculopathy.

Radicular or Radiating pain is often due to compression or injury to the nerve. A slip in the discs between two vertebrae or injury like a fracture or inflammation of the vertebrae causes narrowing of the space present around the nerves in the spinal cord which further causes compression of the nerve. This finally results in radiculopathies. Depending on the type and location of nerve injury, the symptoms of pain are also seen in that region.

Most radiculopathies are seen in the thoracic and lumbar region as it is a region that takes up most of the weight and stress of the upper body as well as balances the lower body.

Causes of radiculopathies:

  • A protruded disc causes narrowing of the space

  • Degenerative disc disease is seen commonly in aged individuals

  • Sciatica or inflammation of the sciatic nerve in the posterior aspect of the leg

  • Tumours of the spine

  • Arthritis of the spine

  • Spinal stenosis is a condition where there is a narrowing of the spine.

  • Spondylolisthesis is a condition where the vertebrae shifts from their position.

  • Scoliosis is a condition where an abnormal curvature of the spine is seen

  • Poor sitting posture and improper lifting techniques

Radiculopathy symptoms:

Symptoms of radiculopathies are common, notwithstanding the region, which it is arising from. Lumbar radiculopathy or thoracic radiculopathy would have the same symptoms except for the region the pain is originating from. Symptoms like:

  • Tingling or numbness sensation in the course of the nerve

  • Sharp shooting pain or burning pain

  • Sharp pain starting in the back and extending to the leg

  • Pain aggravates on sitting or coughing

  • Hypersensitivity in the affected region

Treatment of radiculopathy:

Non-steroidal drugs and painkillers for pain can be prescribed by doctors’

Ice and heat application to reduce the pain sensation felt in the affected area as prescribed by a specialist

physiotherapy - a physiotherapist would assess the cause, region and symptoms associated with the radiculopathy, taking into consideration the activities you repeatedly perform during your day-to-day activities.

3. DISCOGENIC BACK PAIN

Discogenic pain means pain that originates from the disc present in between the vertebrae. Any changes in the structure of the proper functioning of the disc which is present in between the vertebrae can cause pain known as discogenic pain.

Causes of discogenic pain:

  • Internal disc disruption is a condition in which there a crack or tear appears in the disc which causes pain in movement

  • Any condition that causes the disc to shift from its position can cause discogenic pain- for example, Intervertebral disc prolapse.

  • Degenerative disc disease is a condition seen commonly in aged individuals wherein the disc undergoes normal degeneration causing pain in the area.

Symptoms of Discogenic pain:

Any activity that may increase the pressure on the disc causes painful symptoms, like:

  • Increased pain in bending forward, sitting and standing for a prolonged period

  • Neck pain experienced on the tilting of the head

  • Spasms or catches felt in the muscles surrounding pain

  • Central one area pain which increases on the activity as most discogenic pain do not radiate or travel to another body part like radiculopathies.

Treatment of Discogenic pain:

  • Medications like painkillers and nonsteroidal drugs can help in reducing the pain and inflammation if present.

  • Ice or heat therapy to relieve pain without medications

  • Bracing to help support the spine and other structures surrounding it. This reduces the occurrence of painful episodes due to jerky movements which are not possible with braces.

  • Physiotherapy is a highly recommended path for the treatment of discogenic pain. A combination of exercises along with postural corrections and advice while performing an activity during day-to-day activities is given by the therapist. Core strengthening exercises are often helpful in relieving pain and strengthening the surrounding musculature.

4. SPINAL STENOSIS

Spinal stenosis is a condition characterized by narrowing of the space in the spine. Narrowing of the space results in compression of the structures present in the space like the nerves, muscle tendons, ligaments etc.

Causes of spinal stenosis:

  • Overgrowth of a bone is usually seen due to wear and tear of the bone. This causes the bone to break into small fragments and occupy space.

  • Herniated discs

  • Thickened or hardened ligaments that occupy space and restrict movement of the vertebrae

  • Tumours formed in the spinal cord

  • Injuries to the spine can accuse dislocations or fractures of the vertebrae

Treatment for spinal stenosis

  • Non-surgical treatment for spinal stenosis includes medications, injections and physiotherapy

  • Surgical treatments are also a preferred alternative for spinal stenosis management.

CONCLUSION

Back pain in itself is a combination of many types, causes and symptoms which can be broadly categorized into mechanical, radiating, discogenic and spinal stenosis pain. The type of treatment and prognosis of each condition is unique in themselves. Consulting a physiotherapist for a non-invasive, conservative cure for back pain is the best help you can do yourself.

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