Back Pain Treatment
Back pain is a condition that affects millions of people every year. Most people experience it at some point in their lives. At any given time, pain research shows that around 25% of adults are suffering from back pain.
The human back is made up of a complex network of muscles, ligaments, tendons, discs, nerves and bones called vertebrae. All of these structure work together to provide both stability and movement. They also serve to protect important structures like the spinal cord within the spinal canal, as well as nerve roots. A disruption to any of these structures can trigger an episode of back pain.
Types of Back Pain
Most episodes of back pain fall into the category of acute pain, where symptoms resolve within 2-6 weeks. For some, however, symptoms can linger for up to 2 months. Only a small portion of people will go on to develop chronic low back pain where the pain persists for over 12 weeks.
Back pain can be divided into 2 main categories:
Acute Back Pain
Back discomfort that lasts for a few days to a few weeks is known as acute or subacute. The majority of low back pain is acute. It usually goes away with or without treatment and there is no resulting functional loss.
Chronic Back Pain
Can be defined as pain that lasts for 12 weeks or more. Typically, less than 10% of people affected by acute low back pain go on to develop chronic pain with persistent symptoms.
Causes of Acute and Chronic Pain
For most episodes of acute back pain, the underlying cause is an injury to the soft tissues in the back, such as a muscle strain or ligament sprain. These injuries are common and typically occur after an accident or from heavy activity- especially if it is something that a person is not used to. This may trigger mild to severe pain and can also cause muscle spasms at times.
Chronic pain is often complex and multi-dimensional and can occur with or without any kind of initial injury. It can be very difficult to identify one underlying cause since there are typically many contributing factors that result in this condition. Factors such as, physical and mental health, fitness/activity levels, and stress levels are just a few examples of elements that can contribute to the development of chronic pain.
Neuropathic pain usually results from an upset to the nervous system itself, such as with nerve compression or irritation. Neuropathic pain can be either acute or chronic. Symptoms of nerve pain can include shooting, burning or sharp pain, numbness or tingling, and increased sensitivity to touch. Conditions that irritate the sciatic nerve, for instance, can cause shooting pain and symptoms into the leg. Leg pain and numbness or tingling can sometimes travel as far as the toes with sciatica and often feels worse when the nerve is stretched with certain legs’ straight positions.
Occasionally, some medical conditions can cause acute or chronic back pain, such as kidney stones or spinal stenosis. Other medical conditions, such as osteoporosis, can increase a person’s risk of developing broken bones, such as compression fractures in the spine. There are even some connections between certain musculoskeletal and skin diseases, such as psoriatic arthritis. It is always important that medical providers screen patients for underlying medical issues that may require further investigation during their assessment.
Assessment of Back Pain
The most important first step in treating lower back pain is having a thorough assessment done by a qualified medical practitioner. Physical therapists are primary care providers and are therefore qualified to assess and screen patients without needing a doctor’s referral. A physical therapist will always advise if they think further investigation by a physician would be beneficial, such as for an x-ray or blood test. If you have already had diagnostic imaging, these reports can be brought to your assessment.
Your assessment will begin with a detailed history with questions like:
- When and how did the back pain start? What activities tend to aggravate it?
- Are there certain activities that you are unable to do because of your low back pain?
- Have you tried any other back pain treatments and what helped or did not help?
Next would be a physical assessment which may include some of the following:
- Checking the range of motion of your lumbar spine and lower or upper body.
- Checking the strength of the limbs, back, and stomach muscles.
- Testing the nerves for function and sensitivity as well as screening for neurological disorders.
- Palpation of the spinal joints and soft tissues to check for spasm and tenderness.
Treatment of Low Back Pain
- There are many different ways to effectively treat back pain. One thing that should be avoided however, is bed rest. Academic research institutions have shown that while some rest and position changes may be needed at times, complete bed rest is no longer recommended because it can make back pain worse. Laying in bed too long has been shown to delay recovery and cause muscle weakness and stiffness.
Managing Low Back Pain at Home
There are many options for managing lower back pain at home.
- Hot and cold packs can be used as often as needed to help relieve discomfort.
- Walking, gentle activity, and movements that don’t flare the pain can help your mobility and promote blood flow and healing.
- Frequent position changes can provide some back pain relief. Try experimenting with different positions, such as placing a rolled-up towel behind your back when sitting to relieve pressure on your back.
- Gentle pool exercises can help to relieve pain and increase mobility. This can include swimming or just simply walking and moving in the water.
- Over-the-counter medications such as Tylenol and Advil may temporarily help relieve pain caused by a back injury, but they should not be used for an extended period of time.
After a thorough assessment, your physiotherapist will develop a treatment plan to help you achieve your desired goals. These goals could be to reduce pain symptoms, improve mobility, regain strength or be able to do a certain activity. For some, this might mean being able to lift their kids, play soccer, walk to the grocery store or return to work to name a few.
A physical therapy treatment plan can incorporate a variety of elements such as:
- Education about your back problem and how to treat it.
- Hands-on techniques such as massage, joint mobilizations, and assisted stretches.
- Exercises and stretches to regain your mobility, strength, and function. Physiotherapists often include exercises to improve the strength of the back and abdominal muscles or core muscles.
- Modalities that may help with pain management such as hot/cold packs or transcutaneous electrical nerve stimulation (TENS) which may help to block pain signals.
Physiotherapists can also provide assistance with return to work or return to sport planning after a back injury. They are also eligible to provide care under MPI claims for those injured in motor vehicle accidents and WCB claims for those injured at work.
Physicians can also provide medical advice to help manage back pain. They may be involved with screening for medical conditions, performing any necessary diagnostic tests, and prescribing treatment. Pharmacological treatment with medications such as nonsteroidal anti-inflammatory drugs (NSAIDS), muscle relaxants, and pain relievers can only be prescribed by a physician. They can also refer to a specialist if needed. It is extremely rare for anyone with back pain to require any form of surgical treatment. Current evidence shows that conservative treatment methods are usually more effective in helping to treat back pain.
There are many other alternative treatments that may help in the management of back pain.
- Acupuncture, which involves the insertion of fine needles into various points in the body, can be helpful in the management of painful conditions. Many physiotherapists are licensed to practice acupuncture.
- Relaxation techniques such as meditation and breathing exercises as well as stress reduction strategies can help to reduce pain signals and muscle tension.
- Cognitive-behavioral therapy can be a helpful tool for those dealing with chronic pain.
Other Sources of Pain Relief
There are many other elements that have proven to be helpful in the management of pain and general health such as:
- Getting enough sleep. Most adults need 7-9 hours per night.
- Being able to maintain a healthy weight.
- Practicing exercises such as tai chi and yoga
- Eating a healthy diet rich in vegetables, fruits, legumes, nuts, and whole grains