What is Back Pain and Why is it so Common?
Back pain is one of the most common issues that we assess and provide treatment for at Rebalance Sports Medicine. This is not surprising considering that the majority of our patients are office workers in the downtown Toronto, financial district.
A few reasons why back pain has become so common among Canadians include:
- High volumes of sedentary desk work
- Poor postural habits
- Low activity lifestyles
- High proportion of social and recreational activities that involve sitting
- Too much screen time starting at younger ages
Pain felt in the low back, buttocks or even the legs can all be attributed to issues stemming in the lower back and pelvis. The nerves that control the strength and sensation in the legs originate in the low back (lumbar spine) and are most vulnerable to compression, angulation or irritation as they exit the spine. If this occurs, your lower back issue may also develop into leg pain/tightness or symptoms of sciatica.
Back pain can be debilitating and influence not only your ability to work but can also impact all aspects of life. If back pain is not managed appropriately in the early stages, it can turn into a more chronic condition with repeating re-occurrences and ongoing discomfort. It is important that you have your back pain assessed by a medical professional be it a Physiotherapist, Chiropractor or Sports Medicine Physician. It is important to seek treatment for your back at the onset of pain or stiffness. Early intervention can lead to a faster recovery, can prevent worsening of symptoms and will limit compensations strategies from taking over and leading to a more stubborn, chronic condition.
What Makes the Lower Back Unique?
The back takes on heavy loads across a lifetime and it’s also an area where there is a decent amount of movement (forward bending, backward bending, sideways bending and twisting). The lumbar spine does have some unique features that help to protect it:
- Size of the vertebra and intervertebral disc are designed to take load- the bones are larger and denser and the disc tissue has an intricately designed pattern so it can take loads in multiple planes of movement. Also, the joint architecture limit end ranges of twisting movements which can strain the disc.
- Its relationship with the pelvis- The lumbar spine is closely related to movements of the pelvis and hips. These areas have a close relationship to one another. If one area fails other areas can compensate and take the load, create stability or offer flexibility. In the long term, these compensations can lead to secondary damage/injury but in the short term, this can be quite protective for the low back.
- Its natural lordosis or curvature- the spine in our low back anatomically has a concave curve forward to which transitions to a convex spine in the midback. These curves are important for proper weight bearing through the disc and vertebrae but often become reversed or changed with poor postural habits.
The lumbar spines movement is influenced by many areas of the body from feet to shoulder. It is the commonly considered the core or power house that drives movement. We all hear the buzz word “core strength” but to truly understand what the core is a lot of us need the guidance from a knowledgeable professional or trusted physiotherapist. It’s important that we recognize that core deficits can be different in each of us and the best core exercises are very individual and unique to each person’s body and demands.
What are the Causes of Back Pain?
Back pain due to muscle strains or joint sprains (Mechanical back pain)
Mechanical back pain is a general term and describes when muscles, ligaments and joints of the low back get injured. When excessive demand is placed on one or more of these structures they can become strained/sprained and an inflammatory response will ensue. A strain/sprain more commonly occurs with a sudden demand is placed on the tissue and fibers tear. Proper rest and gradual rehab exercise can lead to a favorable recovery.
Back pain due to the facet joint dysfunction
There are two paired joints on either side of a vertebra that connect the vertebrae above and below. These joints are called facet or zygapophyseal joints. These joints glide, gap and rock as the back moves. They can have variations in how they form from birth or can be damaged or sprained with trauma. Extension or leaning backwards (arching your lower back) causes compresses at these joint surfaces and is one of the most common ways to injure this area. If you are having pain coming from the facet joint it will be localized to that specific area in the back and may also impact the exiting nerve root causing leg symptoms. It is important you get proper diagnosis and treatment for this injury to resolve it and prevent future occurrences.
The interverbal disc is a commonly injured area of the spine that can lead to nerve compression and associated symptoms down the leg when it involves the discs of the low back. It is injured with compression and rotation which will occur with a bend and twist movement or can also occur with prolonged sitting in poor postures. Pain with a cough or sneeze is another common sign that a disc had been injured. There are different levels of severity with disc herniation’s ranging from a bulge, prolapse to a sequestered disc. The most common is a bulge but as the injury progresses it may become larger and advance towards a sequestered disc lesion. It is important to seek treatment from a trusted physiotherapist or chiropractor right away to prevent any further damage and promote resolution of symptoms.
Degenerative changes in the disc will occur across a lifetime. By middle age, the majority of the population will see some degree of degenerative change in their spine with imaging. It is a normal part of the aging process…like the wrinkles that develop on the outside. However, a history of back trauma or pain will likely cause more symptomatic and earlier onset of degenerative changes. As we age, the disc becomes less fluid and when there is excess pressure pushes on it, it can start to wear down more easily. When the disc wears down, sometimes an inflammatory process ensues which can cause pressure around the nerve and ultimately cause symptoms down the leg. Often, individuals with symptomatic degenerative disc issues complain of stiffness and decreased load tolerance which results in regular flare ups. The good news is that many people that have radiographic evidence of degenerative changes do not have any symptoms and lead normal, active lives. The best part is that conservative management with physiotherapy or chiropractic can be very helpful at managing symptoms when and if they do exist.
Stenosis means narrowing of a pathway. The back has exit pathways for the nerves leaving our spinal cord travelling down to innervate our lower limbs. Depending on the extent of the abnormal narrowing of these passageways “stenosis” can result in compression around the exiting nerve and may result nerve like (sciatic like) symptoms. This narrowing is also part of the normal aging process but a previous injury or dysfunction will result in stenosis occurring earlier and with further severity. Physiotherapy and chiropractic interventions can be helpful at targeting the pain and improving function with this condition.
Back pain due to Spondylolisthesis
This injury occurs when one boney vertebra slips forward on the adjacent vertebra. It can happen in the lower back with a traumatic injury or in the case of repetitive strain (typically related to repeated extensions or over-arching). When this injury occurs, the ligaments become stretched/strained and a certain aspect of the vertebrae breaks down. This results in a forward slippage and ultimately the bony integrity of the spine bone can no longer maintain normal alignment. There are different types and varying severity of slippage that are described further in the attached article. LINK to Spondylolisthesis article. Thankfully, physiotherapy and chiropractic treatments can serve as an excellent conservative approach to treatment in most cases.
Back pain due to Scoliosis
Scoliosis is an abnormal veering of the spine in a sideways/rotational direction. There are different types of scoliosis, you can be born with scoliosis, develop it after an injury or develop it gradually over time due to postural habits. Our spines can accommodate for some mild angle changes but when they become significant this can change the biomechanics of the spine which can ultimately lead to discomfort. It is important that you seek advice from a health care professional on how to treat your specific case. Your trusted physiotherapist or chiropractor will guide you on an individualized prescriptive exercise program and healthy spine practices.
Back pain with Sciatica/Radiculopathy
Irritation of the sciatic nerve creates pain that can be sharp, burning, shooting or tingling down the side and back of the leg. The sciatic nerve is large nerve that exits at the lower back and travels through the buttock and along the back of the leg. It can be compressed or irritated by several structures which can include: (1) disc herniation/degenerative disc disease, (2) spinal stenosis (3) spondylolisthesis (4) tight piriformis muscle (5) adhesions in the hamstring muscle and fascia. A radiculopathy is another common issue and describes the situation when there is compression to a nerve root that is exiting the spine and causing pain, numbness, weakness or tingling along the course of that nerve. In both of these conditions, pain is likely to persist in the lower extremity but it is important to remember that the pain itself is originating in the low back and treatment must be directed there.
How can Physiotherapy, Chiropractic, Massage Therapy and a Sports Medicine Doctor help your Back Pain?
A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist and/or Chiropractor can include controlling pain with therapeutic modalities, acupuncture or dry needling. They will also help you regain full mobility of the joints by incorporating hands on manual therapy. Exercise therapy will also be a part of your care and individualized therapeutic exercises focussed at improving mobility, strength and motor control will be taught as needed. Soft tissue release is also an important aspect of care and you may also require adjunct massage therapy treatment to address any soft tissue adhesions that exist. Education in regards to lifestyle modification, pacing, fear avoidance and other topics will also be addressed as required. Here at Rebalance Sports Medicine you have access to our unique Clinical Pilates program where our highly trained Pilates instructors work under the instruction of your physiotherapist to build your core strength as well as any other areas of weakness. Here at Rebalance, our patients also have access to our knowledgeable Sports Medicine Physicians for further investigation and analysis if your treatment is not progressing as expected.
How Long Does it Take to Recover from Back pain?
The answer to this question is not simple as there are many factors to consider. In general recovery can take a few weeks up to a few months. In most cases back pain can resolve or be managed to appropriate levels so it does not impact your day to day life. In the severe cases a referral to orthopedic specialists who may choose to perform nerve blocks or surgery can be indicated. Only a small amount of chronic back patients require surgery and it should be considered only after conservative management measures fail. In any case, mild to severe, it is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your home exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a Sports Medicine doctor for further investigations or explore alternate treatment options.
What are the Best Exercises to Help with your Back Pain?
A well-rounded program should address breathing deficits, core strength, back mobility, hip mobility and graduated progressions. These exercises should be individualized to your particular needs and goals.
Some of the most common exercises are linked below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after their performance. For motor coordination please preform them paying close attention to good form, in a slow and controlled fashion and about 3 sets of 10-15reps.
Dead Bug or Bird Dog
Direction Biased Exercises
For relief you will choose to stretch in the opposite direction pain is created.
Pain increased with bending forward or prolonged sitting -then Lumbar extension is most likely to provide relief.
Baby Cobra – For this exercise lie down on the floor on your stomach and using your arm strength lift your shoulders and upper body off the ground while keeping your low back relaxed. Hold 10 sec repeat 5-10x as long as it is pain free.
If pain is increased with prolonged standing or arching backwards then Lumbar flexion is most likely to provide relief.
Knees To Chest- For this exercise lie down on the floor on your back and pull both knees into your chest using your arms to lift and hold them. Hold 30sec 2-3x
Figure 4 Hip Stretch
Lying on your back with your knees bent and your feet flat. Take the leg of the hip to be stretched and place the ankle on the lower thigh of the bent knee and turn your knee out so that your legs position now looks like the number 4. Grab behind the knee of leg that is on the ground and pull it up towards your chest. You will feel a stretching sensation deep in the buttocks of the crossed leg. Hold 30sec and Repeat 2-3x.
How to Treat Back Pain on Your Own?
- If you have acute onset pain in your back you may first want to try ice over the area. If the pain has more of a gradual onset or has been lingering for some time then heat might be the better choice. You may also choose to apply both intermittently depending on how they make your symptoms feels. Ice or heat should be applied for 10min and then a 10 min break. You can repeat 3-4x.
- You should also try to figure out the positions and activities that can aggravate your back pain. Pay close attention to the positions that make you feel worse such as sitting or walking/standing for prolonged periods. Try to modify these positions or avoid them for a temporary time until you can gradually reintroduce them as you get stronger with your exercise regime.
- If you sit for prolonged periods a lumbar support roll can help with your sitting posture and take stress off your spine. Most office chairs although advertised as ergonomic are not build for our individual needs and this added support can make a big difference to how you feel. If you have further questions about your desk set up contact us to make use of our ergonomic program where an expert in the field can ensure proper desk set up and equipment.
- Start basic core exercises and gentle low back and hip range of motion exercises as early as possible.
- If the pain continues and does not respond to the aforementioned strategies, then over the counter pain or anti-inflammatory medication might be indicated, talk to your pharmacist or family doctor to help direct you.