I did not do anything, why do I have back pain?
Back pain most often occurs with no cause. This means that their no specific injury that people can point to and diagnosis is difficult. Often times back pain is due to accumulation of stresses found in our day to day lives. This can include work, how we sit, lack of exercise, time we spend in the car, and a number of other things we do on a regular basis. Back pain then seems to occur randomly or with a movement we do 10s or 100s of times a day. If this is how you feel your back pain came on physical therapy is perfect to help you in your recovery. At Ascend we provide you with the guidance, hands on care, and treatment you need to see changes in your back pain. The good news is with guidance most people recover from their back pain. If your pain has been around for more than a week it may be time to see someone.
Can stress contribute to back pain?
Stress contributes to pain. Just like an amplifier the volume increases when we are under stress. After prolonged back pain stress may be a primary factor on why you have been unable to recover. Controlling stress is key to reduce pain and improve function when it comes to low back pain. Often times we are not able to manage our stress, anxiety, or depression ourselves and need support from a psychologist to help relieve our symptoms and improve both mentally and physically.
What is a sacroilliac joint (SI joint) problem?
The SI joints are between the bones of your pelvis and the spine and have very little movement. Some people have been told this is slipped or rotated out of place but short of a fracture this joint simply does not move enough to be out of place. The movement of this joint is on average 2-5 degrees meaning that we can not detect if this joint is out of place. Pain in this area may be due to inflammation or irritation that occurs after a fall or childbirth which PT can reduce. If you have sensitivity of this area physical therapy can help reduce your pain with mobility exercises, strengthening of the surrounding area, and manual therapy.
What is degenerative joint disease (DJD)?
DJD is a normal change in the body over time. It occurs when the joints lay down too much bone and the joints of the spine shrink in size. This may not relate to your pain because it is something that happens as we get older. Pain that starts low and increases gradually over years may be due to DJD. An exam will help determine if this is the case. Treatment involves mobilization, exercise, and activity modification which can reduce back pain due to DJD.
What is spinal stenosis?
The diagnosis of spinal stenosis is a due to a biological narrowing of the space of the spine. This is a version of DJD where the changes to the spine causes the spinal cord space to narrow. This can result in nerve pain, numbness, or altered sensation. Although physical therapy can not reverse the changes in the spine it can decrease related pain through treatment of the hip and pelvis along with the back. PT has shown to be effective in reducing pain related to spinal stenosis and an examination can help reduce your pain.
What are spinal stress fractures?
Spinal stress fractures are most common in the lumbar spine. They occur when too much stress causes small cracks in the bone. This occurs most often in those with osteoporosis, or poor bone health. If severe the position of the bones of the spine can change which can cause pain or nerve problems. Treatment for spinal stress fractures include a reduction in activity and a period of rest. A back brace may be prescribed and you will need to have x-rays done to monitor the fracture. If the fracture progresses you may need surgery to stabilize the bones. After the fracture is stable physical therapy can help you recover motion and strength and reduce residual pain.
What is a spondylolithesis?
A spondylolisthesis is a diagnosis in which a part of the vertebrae is weakened and causes one vertebrae to move forward, or backward, on another. If this condition is causing weakness or changes to your bowel there is a concern and you should consult a surgeon. When this is a finding on x-ray it may not be the reason for your pain however. Conservative treatment can reduce pain and tingling and there are many people who fully recover without surgery. Research has shown that even with high grade shifts (grade III and IV) after 18 years there is no difference between those who mange symptoms conservatively, such as with physical therapy, or those who have surgery.
What is a bulging disc?
A bulging disc is when the disc material around the spine stretches out. This can put pressure on the nerves and cause pain. This is a common finding on MRI, however, and may or may not be the source of your pain. Because the bulge is due to a stretch of the disc most people need movement to help the area feel better and recover. Physical therapy will focus on finding the specific exercise, or movement along with manual therapy to help the area feel better. These changes may spontaneously recover and multiple MRIs tend to show different things. A bulging disc that shows on MRI may not show on a second.
What is a herniated disc?
Disc herniations are a normal finding in the spine and a common diagnosis. One of the discs of the spine has a partial tear which causes part of it to leak out. This causes pain for the nerve and back and can occur with just repetitive stress. The body can however recover from herniation, without surgery, with a gradual increase in your activity level. Repeated MRIs of people with disc herniations have shown that they can be reabsorbed and heal. Treatment with physical therapy can get you on the right track with specific exercise designed for your body. Manual therapy and nerve mobility exercises may also help you recover faster.
What does chronic back pain mean?
Chronic back pain is back pain that has been going on for over 3 months. The reason you may have this diagnosis is that structures in the body heal in about 3 months. If you still have symptoms there is no biological reason for the pain to be there. This means that the body is still in pain despite the recovery of tissue damage. This also means that you will need a change in treatment strategies to see improvement. Most people with chronic back pain can recover but it takes a change in their day to day activities and a focus on a gradual increase in activity to improve.
What is radiculopathy?
Radiculopathy is nerve pain that originates from the spine. This can be due to inflammation, compression, or trauma. In a lumbar radiculopathy the nerves of the lower back become irritated and may tingle, be painful, decrease sensation, or decrease strength. Treatment with a focus on calming down the nerves and reducing the irritation are key for recovery.
What is myelopathy?
Myelopathy is a significant compression of the spinal cord that causes symptoms similar to spinal cord injury. The source can be in the neck or upper back and is uncommon in the low back but you can feel symptoms in the legs and low back as well. This may cause you to have pain, difficulty walking, numbness/tingling, weakness, problems with balance, or loss of urinary or bowel control. Treatment typically depends on severity which means early help is better. Physical therapy can help reduce pain and nerve irritation by helping the nerves move and reducing the irritation with hands on treatment. Advanced symptoms may need surgery to increase the space for the spinal cord but is not for everyone.
What is sciatica?
Sciatica is a specific type of nerve irritation where the sciatic nerve is irritated. This can be due to a number of reasons which include irritation at the spine from inflammation or pressure, falling on your butt, or prolonged positions that put the nerve on stretch. Symptoms include numbness, tingling, and pain. Treatment will focus on reducing the origin of irritation and improving the nerve comfort. This may require modification during your day to find relief which PT can help you discover.
What is mechanical low back pain?
Mechanical low back pain is pain that occurs with movement. The provider does not suspect that it comes from another origin such as an organ or cancer. This means the provider thinks the problem is not due to cancer, organ issues, or a systemic problem. Treatment usually includes limiting certain activities, specific exercises, and a gradual return to your usual activities as symptoms decrease. Manual therapy may also help reduce pain in the short term.
Is my leg length difference causing my back pain?
There is no evidence showing a leg length difference causes pain. This is probably due to the fact that if we have a true leg length difference we likely had it for multiple years. If there is tightness and guarding you may move differently that contributes to your back pain. If this is the case the muscle overwork may contribute to pain. With a focus on the tightness and guarding physical therapy can help.
I was told my back is out of alignment do I need an adjustment?
Backs do not move in and out of alignment. This is a myth in use by some health care providers to sell treatment. Research into this area and that of subluxations consistently finds that they do not exist in the chiropractic sense and you can go to multiple adjustments in the same day and have different things found. Although manual therapy has been shown to help back pain, the alignment change is not the reason for the benefit, but rather that their are positive effects on the nervous system.
Have other questions on imaging for low back pain? Ask in the comments below!