Common injuries we can treat at the lower back
Acute lower back pain
Short-term or acute back pain is the common type of back pain, and usually resolves itself in three days to six weeks, whether or not you have treatment. This could be a muscular strain or facet joint sprain. This pain will come on suddenly and is usually on one side of the back. Movements will typically make tis pain worse, and advice on exercises, postural re-alignment from our physios and a couple of Panadol are recommended to get you back pain free. Xrays and scans would all show a normal spine and are not necessary. Keep moving and avoid bed rest if you can.
Mechanical back pain
Mechanical back pain or ‘postural back pain’ is the most common cause of lower back discomfort.
It is characterised by stiffness felt usually in the morning and the pain getting worse throughout the
day. Changes in postures will relieve the pain and it rarely refers beyond the buttocks and upper
thighs. This pain can be due to the fatigue of supporting structures such as the muscles and joints of
the back, making them sore and tight. Pain can cause a compounding effect on muscle strength as it
inhibits the correct control and endurance of the supporting muscles.
Physiotherapy treatment of ‘postural back pain’ involves thorough assessment of alignment,
movement, movement control and postural muscle strengths and balance. Management will aim
to realign, educate, and strengthen. Strengthening of the pelvic postural muscles such as the deep
abdominals, pelvic floor and buttock muscles will allow for the best long term outcome.
Disc injuries
The discs sitting between each vertebrae in the back will carry as much as 70-80% of the trunk’s
vertical load and pressures. Due to poor postures or incorrect lifting and manual labour, these discs
can become ‘injured’ or worn out. Degeneration of the discs, called spondylosis is common and, if
mild, is usually felt across the lower back. This degeneration is due to the dehydration of the watery
disc material as we age. There may or may not be a referred pain into the buttocks or legs.
Due to this disc dehydration, the pressure on the discs can increase, particularly in positions
bent forward or in a slump rounded posture. Injuries can occur here, such as disc protrusions or
prolapses, where the disc’s central nucleus can bulge into the other disc material. This in turn can
potentially cause an encroachment on the space where the nerves leave the spine. Due to this
compression on the nerves or from swelling and inflammation, the nerve can become irritated and
produce a specific referred pain down the leg.
Physiotherapy has been shown to be effective in most cases to alter the pressures through the disc
and allow for reduction in swelling and possible irritation of the nerve. However, in some cases, if
there is a less than positive change in pain in 4-6 weeks, or leg and nerve pain is increasing, referral
to the GP and possible referral onto a specialist may be indicated.
Chronic lower back pain
Chronic back pain exists if pain and symptoms persist for longer than three months. If pain doesn't
go away and has a physical and psychological impact, this pain can become chronic and a problem
in its own right. Chronic pain can result in sleep deprivation, depression, irritability and a decreased
quality of life.
If your back pain is not resolved in the short term, a pain management program may help you to get
back on track. Our physios can work with your GP or specialist and teach you how to manage your
medication, develop coping strategies and improve your wellbeing. Strengthening classes coupled
with this education can help you establish a safe and graduated exercise plan. Our physiotherapists
know that staying active can minimise the downward spiral of chronic pain and in fact, can help you
get out of it. If need be, we can refer you to a clinical psychologist, trained in cognitive behavioural
therapy (CBT), can help you build confidence and overcome any obstacles to your recovery.
Osteoarthritis
Osteoarthritis or age-related wear and tear can occur in the many facet joints of the lower back. It is
typically seen in those over 50 years of age. The pain will be felt across the lower back, and mostly
on one side. This pain gradually becomes a problem. Movement of the lower back usually is painful
while rest makes it feel better. There may be some impact on the nerves as they leave the spine.
Physiotherapy management will be very similar as we see with postural back pain. Re-alignment,
joint movements and a strengthening program for the muscles that support the spine are most
beneficial. It is helpful to learn how to find a balance between exercise to prevent stiffness and
maintain good strength, and rest.
Scoliosis
Scoliosis is a curvature of the spine, made most famous by the ‘hunchback of Notre Dame’. These
curvatures can be structural, or postural. Structural scoliosis cannot be corrected and is often
caused by genetic or bone reasons. Postural scoliosis can be due to postural problems or due to
changes in movement due to pain, inflammation or a difference in leg lengths.
Physiotherapy assessment can determine whether the scoliosis is structural (fixed) or postural.
Alignment, posture and movement checks across the length of the spine and pelvis, strength and
postural muscle assessment, tests to eliminate any inflammation, nerve entrapment, and differences
in the length of the two legs are all carried out to work out the best management approach for each
individual presenting with scoliosis. Treatment can involve pelvis and spine re-alignment techniques,
massage and mobilisation, core and postural muscle strengthening and classes. Referral to a
podiatrist may be required if there is any leg length involvement.
Pregnancy related lower back pain
For over 48% of all pregnant women, back pain is the norm. Some research suggests that in even
up to 90% of all pregnancies, this is the case. As any pregnancy develops, changes in posture at
the pelvis and spine become very obvious and extreme. The growing weight of the baby carried
out at front contribute to increased spinal curves and stresses in the back. In addition, pregnancy
hormones to relax the ligaments and other soft supporting tissues at the joints add to the problem
of pregnancy back and pelvic pain.
Physiotherapy can help through these times. Treatment can target the strength of the supporting muscles about the belly,
spine and pelvis. Gentle pregnancy Pilates based classes
that address pelvic floor and deep abdominal strength offer great relief and support for the back.
Prescription of compression garments and pelvic belts when measured up
correctly can offer wonderful relief. Most women that experience pregnancy related back and pelvic pain
will have an uncomplicated return to pain free back movement within the first 3 months after having their baby.
For those few that have lingering problems after this time, help is also available with appropriate
post-natal physiotherapy.
The pelvic joints provide the transfer of weight, movement and jarring shocks between the spine and
the legs. There are two sacro-iliac joints (SIJs) and a pubic joint. Assessment of these three joints should
always be included with any assessment of lower back or hip pain as it is often found that there
may be some involvement of these joints in the complete picture. These 3 joints have no muscles
that control their movement or alignment directly, but do have an intricate system of muscles that
provide their stability and ability to bear heavy pressures.
SIJ pain is usually felt deeply in the buttock. It is often a dull pain rarely extending beyond the mid
thigh. Pubic pain is very localised at the front of the pelvis.
Physiotherapy is effective in managing these pelvic joint pains. Management is focused on
achieving good pelvic alignment through hand on treatment by your therapist, coupled with
improving movement control about the pelvis and lower trunk. Often, precise and slow exercises
targeting the intricate muscular system of the pelvis bring about the best outcome, such as is seen in
The Fix Program Pilates based classes.
