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Back pain is a very common condition that can present in many different ways. About 80% of all adults experience low back pain at some stage in their lives. Your lower spine supports the weight of your upper body and provides mobility for everyday movements including bending forwards, backwards and twisting.
The spine is made up of a total of 33 vertebrae; 7 cervical (neck), 12 thoracic (upper-middle back), 5 lumbar (lower back), 5 sacral (which are fused together) and 4 which make up the coccyx (also fused). The spaces between the cervical, thoracic and lumbar vertebrae are maintained by strong intervertebral discs which act like cushions between the bones and help absorb forces through the spine. Ligaments hold the vertebrae in place and muscles are attached to the spine via tendons. There are 31 pairs of nerves that extend from the central spinal cord and exit the spinal column on each side of the vertebrae. These nerves are responsible for transmitting signals to and from the body and brain
Back pain can be brought on by an acute injury or may accumulate over time and gradually worsen. An acute flare up of back pain can also arise on top of chronic low back pain (back pain that persists for 3 months or longer). Most low back pain is mechanical in nature, meaning there is a disruption in the way the structures of the back work together. If a nerve root is inflamed or impinged, your pain may also extend down into your buttock and leg. As we get older, general degeneration of the spine characterised by normal wear and tear that occurs to the bones, joints and discs may or may not be accompanied by pain.
Some causes of back pain include:
Your physiotherapist will take a thorough history by asking you lots of questions about the location of your pain, how long it has been present for, what may have brought on the pain and what activities or positions worsen and ease the pain. Based on your answers to these questions, your physiotherapist will have an idea of the possible reasons for your back pain. Your physiotherapist will then assess your posture and you will be asked to perform a series of tests to rule in or out these possible causes. Tests may include range of motion, standing on one leg, walking, and strength, sensation and reflex tests. Palpation will also likely be performed to help identify structures that may be causing your pain.
To allow your physiotherapist to gather a good understanding/visual of the biomechanics of your back, and for ease of movement it is usually requested for you to remove your jacket and shirt and possibly change into shorts. Your modesty is of upmost importance so drape towels, gowns and privacy whilst changing are always offered.
Your physiotherapist will explain to you the likely source of your pain and discuss with you some activity modifications that should help reduce your pain. Depending on your presentation, treatment may include soft tissue work, joint mobilisations, passive movements (your physiotherapist moves your body while you remain relaxed), and they will likely send you home with a few exercises to perform before your next appointment. It is important to remain active and resume normal daily activities as soon as possible, while avoiding movements that aggravate your pain.
Imaging investigations are often not necessary in most cases. Additionally, the findings on a scan do not necessarily correspond with the severity of symptoms. Studies have found that people without low back pain show a similar prevalence of degenerative changes in people that do experience low back pain. Imaging is indicated if you are also showing signs of significant neurological deficits or signs or symptoms that suggest a more serious condition. Imaging may also become appropriate if the expected improvement does not occur. MRI scans are generally the image of choice as they can show bones, discs and other soft tissue structures and can identify if something is pressing on the nerves or spinal cord.
Rarely, back pain may be a sign of something more serious. When the following signs and symptoms are present, immediate medical attention should be sought:
Immediate medical attention should also be sought after major trauma (or minor trauma such as a fall in the elderly or osteoporotic patient) to assess for possible fractures.
The team at CSSM have developed years of experience assessing and treating back pain. Clinical tests will be based on each individual presentation and a treatment program will be designed specifically for each client. We take into consideration your current lifestyle, level of activity and your hobbies and interests to make your rehabilitation program tailored to you. We also have a Pilates studio and a gym in the clinic providing further options for building strength and improving flexibility and overall body control.
Content for this page on back pain was prepared by Camberwell Sports and Spinal Medicine Physiotherapist, Ella Hanna. Ella has a clinical interest in spinal injury and rehabilitation. She is a strong advocate for the role strength and conditioning exercise such as Pilates can play in the rehabilitation of back pain.
One of the most important things you can do for your back pain is to remain active! Try to avoid staying in bed all day or sitting/lying on the couch. Don’t be afraid that you will damage your back if you move it. Avoid high impact activities such as heavy lifting and running, but begin lower impact activities such as walking as soon as you feel comfortable. Try to avoid aggravating positions/movements or activities that increase your pain, and increase the frequency of movements that ease your pain. During your assessment, your physiotherapist will help you identify these aggravating and easing positions and will provide you with further advice on activity modifications and a home exercise program.
Depending on your job, work environment and severity of back pain, your physiotherapist may recommended you to take a short time off work. However, getting you back to your normal daily activities is of highest priority, so your physiotherapist will give you advice on how you may be able to modify your work set up to get you back as soon as possible.
Imaging is often not indicated for those with back pain. A thorough subjective and objective examination is often enough to identify the cause of your pain. However, if you are not experiencing the expected relief or recovery by following our advice and treatment plan, then a scan may be indicated. Those who are demonstrating signs of significant neurological deficits or other signs and symptoms that suggest a more serious condition, we will advise you to see your GP or a hospital immediately and you will most likely be referred for a scan. Some of these signs and symptoms include:
Anti-inflammatories may be helpful to settle down back pain. Inflammation around the joints in your spine can be a source of pain and can irritate the nerves that exit your spinal column. If these nerves are irritated, you may experience referred pain into your leg. Settling down the inflammation may help reduce these symptoms. However, there may be other medications more suitable to you and some that you should avoid, particularly if you are already on other medications. It is important to note that as physiotherapists we are not experts in the prescription of medication, and any information or advice given should be followed up with your GP if you have any further questions or concerns.
Surgery is generally recommended only if there is evidence of worsening nerve damage/neurological signs and symptoms and when diagnostic tests indicate structural changes for which surgical procedures are available to correct or improve. Usually it is recommended to trial a period of conservative management first before rushing straight into surgery, however each case will be managed on an individual basis. The decision to see a surgeon will be a combined decision between the individual, their physiotherapist and GP.
Each individual case of back pain is different. In general, acute (short-term) back pain typically resolves relatively quickly, lasting a few days to a few weeks. Chronic back pain, or pain that has existed for a longer period of time may take longer to recover. It is important to follow the advice given to you by your physiotherapist to give you the best possibility of reducing your back pain and returning to your normal daily activities. It is also then important for you to maintain movement and strength around your back to help prevent reoccurrences of back pain. Your physiotherapist can assist with setting you up a longer term home exercise program.
To make an appointment for treatment of your back pain you do not need a referral.
Appointments can be made with any of our team by calling the clinic directly. Alternatively you can make an appointment via our online portal at our website – www.cssm.com.au