Back Pain Treatment
Lumbar Disc herniation
What is it?
Discs within the spine are made up of an inner and outer material. The inner material is known as the nucleus palposus, the outer called the annulus fibrosus. The inner material is much softer than the external, this can cause it protrude into the outer layer and potentially compress the nerve root leaving the vertebra (via the intervertebral foramina). This is what is often referred to as the misleading term of “slipped disc”. The nerve roots in the low back innervate the lower extremity (provide motor and sensory circuitry to your legs). Therefore, this may cause sciatica (Pins and needles, numbness and pain into your buttocks and down the back of your thigh, sometimes extending as far to the toes)
How does it present?
It can cause pain in isolation to one side of the low back, or as “band like” distribution. It may extend further into the buttocks or lower down into the leg/foot, often with a form of neurological discomfort; resembling pins and needles and/or numbness and weakness on the affected side.
Why has it happened?
The low back unfortunately struggles from a mechanical perspective of supporting our weight, and therefore the natural compression through our spines can cause these occurrences. However, factors such as poor posture/muscle imbalances, prior trauma, and chronic overloading will likely increase the chance of occurrence.
How can we help?
By understanding your lifestyle, occupation, and performing an orthopaedic assessment we can address areas that may be predisposing and maintaining your current problem. We would then likely administer a combination of “hands-on” treatment and exercise prescription to help stretch and strengthen the areas to better support your low back.
Lumbar Facet Syndrome
What is it?
Movement is enabled by the vertebrae via a structure on either side known as the zygapophysial joints, or facet joints. These are essentially two platforms enabling a small amount of movement, working collectively with the other vertebrae to enable us sufficient movement to permit our day-to-day activities. These joints are loaded (compressed) when we actively extend (lean backward via our backs or head).Pain and discomfort can arise from these structures due to too much compression. This could be aggravated by occupational stresses, poor posture/muscle imbalances or lifestyle factors. The facet joints also have a capsule that attaches to the adjacent vertebrae, sometime the capsule can tear (similar to how a muscle or other soft tissue can) and will cause pain originating at this joint. Severity of pain varies, but tends to create less discomfort than a disc herniation, and will rarely refer lower than the buttocks with absence of neurological symptoms typically.
How does it present?
Centralised or unilateral (one sided) pain of the low back. The pain may extend into the buttocks or further down the leg. It is uncommon to experience neurological symptoms (Pins and needles, numbness, weakness) into the buttocks and below. Extension (leaning backward) will often aggravate symptoms, however it’s possible, especially at the early stage of injury bending forwards in isolation, or various movements will elicit pain.
Why has it happened?
It’s estimated that 15-40% of low back pain cases originate from the facet joints. Repetitive trauma (lifting, bending, high impact activities) may predispose, postural biomechanical issues that create a hyperlordosis (an increase to the natural curvature to your low back) or abdominal obesity amongst others can increase the risk of this injury.
How can we help?
By understanding your lifestyle, occupation, and performing an orthopaedic assessment we can address areas that may be predisposing and maintaining your current problem. We would then likely administer a combination of “hands-on” treatment and exercise prescription to help stretch and strengthen the areas to better support your low back.
Lumbar Sprain / Strain
What is it?
This means soft tissue damage (muscles, tendons, ligament tears) to connective structures of our low back and pelvis. The severity of injury is graded 1-3 dependant on how much tearing/stretch has occurred to the tissues.
How does it present?
If it’s ligamentous pain can often be elicited by passive movement (a therapist moving the body into certain positions) if its muscular/tendinous it will usually be aggravated by contraction (use/shortening) of that muscle by performing an active movement. However due to the intricacy of the tissues, and inflammation,its common numerous structures have been injured and thus it can be difficult to directly identify a specific tissue. This doesn’t however mean that you need imaging, as the treatment and rehabilitation protocol is still appropriate once anything more serious has been ruled out through case history and examination.
Direct trauma, such as fall, impact, or sports injury can create the occurrence. It can also present due to overuse and fatigue, or sudden unguarded movement i.e., lifting something quickly or incorrectly.
How can we help?
By understanding your lifestyle, occupation, and performing an orthopaedic assessment we can address areas that may be predisposing and maintaining your current problem. We would then likely administer a combination of “hands-on” treatment and exercise prescription to help stretch and strengthen the areas to better support your low back.
Upper Cross syndrome
What is it?
A common muscle imbalance in the upper back, head and neck causing pain and discomfort. More specifically, it caused by tight upper trapezius, levator scapulae, and pectoral muscles, in combination with weak lower trapezius, serratus anterior, and deep neck flexors. Drawing a line between these areas’ forms a cross, hence the term.
How does it present?
Pain around the upper back, shoulders, and/or neck. It might also be causing tension type headaches.
Why has it happened?
This is often caused by working at a desk for long hours. Accumulatively, overtime this can leads to the muscles listed above becoming tight and weak. The muscles then become fatigued/irritable and can create pain as they struggle to continuously support this posture.
How can we help?
Performing a physical assessment, understanding your lifestyle and helping to improve your ergonomics can greatly help with this condition. This would betreated further by stretched and releasing the “tight” areas and providing exercises to strengthen the weaker counterparts.