Should you see a Physio for back pain?
Rosemary Marchese – Physiotherapist and Schroth Physio for Scoliosis
Back pain will occur in about 80% of people at some stage in their lifetime. Back pain can be caused by numerous conditions and it is a common reason for people missing work, visiting their GP or physiotherapist. Back pain can be successfully treated by your physiotherapist, and with some added education you may be able to avoid it happening again. Most of the time the pain is caused by injuries to the ligaments and muscles that support the back. There may be muscle spasms or strain or tears in the muscles and ligaments. At other times there can be more complex causes.
Common causes of back pain
Lower back pain can occur due to many reasons and it is important you find out what the cause is for YOU rather than consult ‘Dr. Google’. Sudden causes of low back pain may include:
- Muscle strain
- Muscle spasms (often occurring to protect the body from further damage)
- Spinal disc injury
- Compression fractures, which can commonly occur if you have osteoporosis
- Cancer of the spine.
Sometimes non-musculoskeletal factors can cause back pain. Your physiotherapist is well trained to screen for these ‘red flags’ and refer you to your GP for further investigation. Most low back pain is musculoskeletal in origin but other non-musculoskeletal causes may include:
- Kidney stones
- Kidney infections
- Abdominal aortic aneurysm
- Infection of the spine, such as osteomyelitis or discitis
- Spondyloarthropathies, e.g. rheumatoid arthritis
- Reproductive causes such as endometriosis or pregnancy complications.
Diagnosis of lower back pain
Lower back pain is often categorised in the following ways:
- Non-specific lower back pain (NSLBP)
NSLBP is where a process of elimination occurs to ensure nothing more sinister has occurred. This type of back pain has a musculoskeletal origin and can occur suddenly or as a result of sustained overstress, e.g. poor posture. Accumulated microtrauma over time can lead to sustained overstress injuries, leading to back muscle strain or back ligament sprain. Degenerative disc disease may be underlying the acute problem as well, which can predispose you to back pain. NSLBP can usually resolve in two to six weeks especially if treated by physiotherapists. Once you have had NSLBP once, you are more likely to suffer again and thus prevention strategies specific to your needs can help with avoiding recurrence.
- Radicular syndromes such as sciatica
Lower back pain can be caused by structural damage that irritates a nerve. The most common nerve affected is the sciatic nerve. Sciatic nerve damage can occur when the L5 or S1 nerve root is irritated, for example by a herniated disc. However other nerves can be affected at other levels too. This can cause sharp pain and referred pain down into the buttocks and legs. Other back injuries can cause radicular symptoms. This may include facet joint sprain, spondylolisthesis (where one vertebra slips forward or backward over another), spondylolysis, degenerative disc disease, spondylosis and back ligament sprain. Sometimes these factors can cause swelling or space occupying material near the spinal nerve, causing the nerve to be compressed or irritated. Other consequences of radicular problems can include foot drop, foot slap and everter muscle weakness that can impact your ability to walk.
Spinal stenosis refers to compression of the spinal canal and tends to happen more as people age.
What should you do if you have lower back pain?
Visiting your physiotherapist can assist you with a prompt diagnosis, early referral elsewhere if needed, including for scans, get you some acute and chronic back pain relief and provide you with prevention strategies to minimise reoccurrence risk. You can be assessed to ensure that there are no neurological deficits including loss of bowel and bladder function, leg muscle weakness loss of sensation and reduced reflexes. Finding out whether you have a radiculopathy, stenosis or musculoskeletal causes (NSLBP) can be your first step in the right direction to preventing further problems, getting pain relief and stopping the situation getting worse.
All our physios are trained to check for red flags, indicating more sinister causes of low back pain, give you a diagnosis, refer for X-ray if needed (note, we will often refer for an EOS which has less radiation than an X-ray) and refer to your GP if required. As our Schroth Physiotherapist for Scoliosis I am also trained to assess and treat scoliosis, which can further compound back pain and problems. All our other staff are also well trained in back care, given the large number of patients that walk through our door with back problems and scoliosis.
Call (02) 89140508 if you have any questions at all.