Back to Basics

Written by Greg Diamond.


Once serious pathology has been excluded, there are generally speaking only three things that could cause back pain... 

As mentioned, this is excluding serious issues, such as ankylosing spondylitis, or spinal stenosis, or disc protrusion with associated radiculopathy, or any other long and scary word combination you may have overheard.

If these specific issues have been excluded, then the diagnosis falls to a more ‘non-specific’ one. This doesn’t mean the physiotherapist doesn’t know what the problem is, it just means that it is less about a specific issue, and more about the way your spine is moving or being moved.

We call it non-specific, though there is often still a certain spinal level or area that most contributes to your back pain. Physiotherapy treatment will be focused on this significant area, while also addressing the secondary issues that stem from this primary area.

Non-specific back pain will come down to three issues:

1)     Lack of movement

2)     Faulty movement patterns

3)     Postural pain

When your pain is due to a lack of movement, you will notice a restriction of movement in one or more directions and it will generally be painful to move into that restricted range. A physiotherapist can address this movement restriction in the back or neck by using a combination of hands-on techniques to lengthen tight tissue and loosen stiff joints. When pain is caused by a lack of movement, the solution is often to get the area that is not moving, moving. This tends to decrease the pain.

Faulty movement patterns are often not at all about stiffness. You may find you still have a full range of movement, but it just hurts when you move. For whatever reason, the current way you move your back is contributing to pain and discomfort. In this instance, physiotherapy is aimed at correcting this faulty pattern. By using a combination of education, facilitation and movement retraining, we help you to re-learn how to move in a pain-free way. This is coupled with analysis of your work and/or home environment in order to find, and perhaps remove, potential causative factors.  With this type of back pain, the approach is less hands-on, as the focus is more on practicing correct movement (both in the clinic and in your home!).

Postural pain is usually due to a repeated posture or load. The best treatment is to remove the causative factor. That may mean to adjust your work-station to allow a more optimal posture, or simply to take more breaks. There is often also some postural retraining by way of education and facilitation.

Often, there is a combination of things going on with a back. Someone might have faulty movement patterns with associated pain, which has then resulted in a guarded posture and the development of decreased movement and stiffness. Someone else might have a stiff back that then causes them to use poor patterns of movement.

Generally, a good physiotherapist will draw from any combination of hands-on or hands-off techniques to best address your back pain in a way that will be most effective for you.

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