Figures suggest that around 80% of people experience back pain at some time in their lives. Back and neck pain can be very debilitating so how a physiotherapist manages back pain treatment is essential to secure a positive result. Back pain can be localised in and around the spine, but can also be experienced as sciatic pain. Headaches and migraines are also commonly caused by neck issues.
Exercise is important
Exercise is gaining recognition as playing a vital role in the long term recovery and in preventing many musculoskeletal injuries, including back and neck pain. Exercise compliments physiotherapy treatment management and achieve long term results when trying to prevent and rehabilitate pain and injury by correcting the underlying causes, not just seeking to stop the pain.
The underlying biomechanics that cause back and neck pain
Most back pain is caused by excessive loading placed on muscles, joints, ligaments, spinal discs, etc. due to poor core stability. Core stability is traditionally defined as; an individual’s strength and control of their lower back, pelvic and abdominal muscles in order to maintain optimal postural alignment of the lower back and pelvis.
However it is important to also include the shoulder girdle and rib cage, as the lower back and pelvis do not operate in isolation, and muscles throughout the torso must act in a coordinated manner in order to maintain optimal postural alignment and also to initiate biomechanically efficient upper and lower limb movements.
A good analogy to help understand core stability is to consider how a tent is supported. A tent is held upright by a rigid tent pole. The bones of your spine act like a tent pole, however your spine is not rigid, so it relies on the support of ligaments and deep stabilising muscles to hold adjacent vertebrae and to help maintain optimal postural alignment i.e. stabilise the spine. If the muscles that stabilise the spine, pelvis, rib cage and shoulder are weak or are poorly controlled then your spine will tend to collapse, just like a tent pole made from a piece of spaghetti. There are many muscles that attach directly onto the spine, pelvis, rib cage and shoulders. These muscles move our torso and limbs and also assist with stabilising the core, acting in a similar way that guide ropes help to keep the tent pole upright. If a tent had guide ropes that pulled more on one side than on the opposite side then the tent would lean, so too, if the muscles on one side pulled more than the other due to imbalances in strength and/ or flexibility, or these muscles compensate for weak stabiliser muscles then they will pull your body into a poor postural alignment. One very important difference to note is that a tent only requires “static stability” i.e. support to maintain a single stationary position, whereas, the human body must have “dynamic stability” to provide support and maintain optimal alignment of their core and limbs whilst moving in many different ways to participate in sport, work and daily living activities.
How a physiotherapist corrects biomechanical faults
Physiotherapists conduct a comprehensive physical assessment and then use this information to design a personalised exercise program to improve posture/ biomechanics, core stability, flexibility, functional strength, cardiovascular fitness, balance and coordination. Programs focus on achieving long term results by correcting the underlying biomechanics causes of your pain, improving the strength of muscles that support your back and neck and teaching efficient movement for your specific sport, work or daily living activities. Expert supervision by an Physiotherapist ensures that each client completes the exercises with good technique to prevent further injury, to ensure that the exercises are effective, and also to ensure that progressions are made at safe and appropriate times.
Headaches are a problem that affects at least 90% of us during our lifetime. There are multiple types of headaches that vary in symptoms and severity, with some of the more common types including tension-type, migraine and cervicogenic headaches. A number of headache types share common contributing factors to their source of pain, including that they often originate or are linked to the neck region. Some of the following signs may indicate that your headache may be neck related:
Pain and tension through the neck
Pain is initiated or increased with neck movement or prolonged neck posture
Neck range of motion is reduced
The pain may be more prominent or localised to one side, or may exist on both sides of the head
Pain may be experienced from the base of the skull and often refer around the skull or behind the eyes
There may be a feeling of dizziness or light headedness
History of acute trauma or repetitive trauma to the neck region
Diagnosis of headache type is critical for effective management and is an area where physiotherapists can utilise their assessment skills to help differentiate which type of headache is present. Physiotherapy invention can be very effective in managing headaches with a cervical spine (neck) related origin. A physiotherapist will assess the joints of your neck, associated muscles and neural structures to identify any abnormalities. Your posture and work ergonomics may also have a significant impact on headache development and persistence, which are areas that physiotherapists have expertise.
Physiotherapy management may include any of the following depending of your specific presentation and symptoms:
Soft tissue mobilisation/massage
Stretching of tight structures
Postural advice and correction
Strengthening of important neck stabilising muscles
Ergonomic assessment/advice for your work place set-up
Stress and tension management
If any of the above physical symptoms are sounding familiar you may find that your pain in the neck was the cause of your headache all along.
A review of medical literature suggests that exercise, alone or in combination with education, may reduce the risk of low back pain, according to an article published online by JAMA Internal Medicine.
Daniel Steffens, Ph.D., of the University of Sydney, Australia, and coauthors identified 23 published reports (on 21 different randomized clinical trials including 30,850 participants) that met their inclusion criteria.
The authors report that moderate-quality evidence suggests exercise combined with education reduces the risk of an episode of low back pain and low- to very low-quality evidence suggests exercise alone may reduce the risk of both a low back pain episode and the use of sick leave. Other interventions, including education alone, back belts and shoe inserts do not appear to be associated with the prevention of low back pain.
“Although our review found evidence for both exercise alone (35 percent risk reduction for an LBP [low back pain] episode and 78 percent risk reduction for sick leave) and for exercise and education (45 percent risk reduction for an LBP episode) for the prevention of LBP up to one year, we also found the effect size reduced (exercise and education) or disappeared (exercise alone) in the longer term (> 1 year). This finding raises the important issue that, for exercise to remain protective against future LBP, it is likely that ongoing exercise is required,” the study concludes.
1.Mark J. Hancock, PhD et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, January 2016 DOI: 10.1001/jamainternmed.2015.7431
How do we prevent workplace repetitive strain injury? MOVE
Office work will become much less of a pain in the neck if Julie Côté has her way. That`s because this kinesiology researcher who teaches at McGill University is interested in finding ways to reduce or even prevent the kinds of muscular and skeletal stresses and pains that will affect one in ten office workers at some point in their careers. “Even though office workers may not naturally see it that way, their body is basically their work instrument, just as it is for an athlete,” says Côté. “It can get injured in similar ways and for similar reasons: overuse of certain muscles.” One of her current experiments involves looking at treadmill workstations. “These workstations may be good for getting people moving and losing weight,” says Côté, “but no one has looked into how this kind of posture affects the muscles in the neck, shoulders and lower back.”
She and her fellow researchers asked experiment subjects to complete a 90-minute typing task while walking or sitting, while they measured muscle activity in the neck, shoulders, forearms, wrists and lower back. The researchers discovered that there was lower but more variable neck and shoulder muscle activity when subjects were walking compared with sitting, all of which translates into less discomfort. So treadmill work stations are potentially helpful in reducing the neck and shoulder muscle pain associated with computer work.
Athletes of the workplace
Côté developed an interest in doing research into muscle strain at a time when she was dealing with physical injuries caused by her own training schedule. She had been a serious middle distance (800 m) runner for over a decade, starting in her teens, running 100 km a week and feeling great about it. She had the speed and skill to move from the provincial level to the national and then on to international competition, becoming the National Junior Champion and representing Canada in the World Junior Championships in Bulgaria in 1990. In 1995, she went to the World University Games in Japan as part of the Canadian National University team, and a year later, she made a bid to become a member of the Canadian Olympic running team.
“It didn’t work out, I started to develop all sorts of health problems and injuries,” says Côté, pragmatically. “But I was gradually starting to get more interested in the research than I was in the running, my focus was changing.” She had realized that she could help a lot of people by looking into the causes of neck and shoulder pain, one of the most common complaints of office workers. “Whether you’re a computer worker or a middle-distance runner, injuries happen when you tense a particular muscle or group of muscles for too long, and the blood can`t flow into the region as it should and regenerate the muscles. Bodies are made to move.” Her solution to reducing muscle pain for office workers is simple: minor movements and adjustments of position every few minutes.
1.Larissa M. Fedorowich, Kim Emery, Julie N. Côté. The effect of walking while typing on neck/shoulder patterns. European Journal of Applied Physiology, 2015; DOI: 10.1007/s00421-015-3163-3