To understand why back pain recurs, we need to first look at why pain occurs to begin with and then how back pain physiotherapy can help. Back pain generally stems from some form of trauma or loading placed on your back, which may occur as a one off incident or be repetitive loading over time. Normally your core muscles will control your spine and allow an even distribution of load in the appropriate tissues. However, in an acute incident or with poor biomechanical control these muscles will not be able to withstand the load placed on them and trauma will occur. This trauma may cause damage to the tissues within your spine including the disc, joints and muscles.
It is essential to determine how and why the injury occurred
Once your back has been subjected to trauma the damage sustained may alter thestructure of your spine, including arthritis within the joints, disc disruption or bone alignment. Whilst physiotherapy will aim to alleviate your pain, regain full spinal movement and prevent further spinal damage it is important to determine why the injury occurred to understand the underlying cause and surrounding factors so that the same incident is not replicated and your back can be appropriately managed in the long term. The most important aspects of this management include altering your biomechanics to optimise your back function, modifying any activities which may aggravate your back, having optimal sleep postures and implementing an exercise routine including stretches and strengthening to maintain appropriate muscular stability and flexibility.
Biomechanical corrections are vital
Biomechanical corrections are vital to allow appropriate load distribution throughout the spinal column. The spinal column is very long, thin and has attachments to the other major structural components within your body. There are many different muscles which attach to it which can pull each individual spinal segment in a different direction. Those with back pain will often be overactive in particular muscle groups and under active in others, particularly their ‘core’ muscles. Your physiotherapist is likely to discuss these with you and may make alterations depending on your particular posture. It is important that following your treatment you continue to maintain these alterations. This may mean the need to continue stretches and specific strengthening exercises longer term to prevent reverting back to previous postures.
Activity modification is often required
Activity modification is often required to prevent re-injuring your back after your injury. Most people will have specific movements or activities which will cause them pain during the recovery from a back injury. It is important to take note of these activities and understand why they are painful so that once your pain is gone you are still aware of activities which are most likely to cause you pain in the future. You may need to modify these activities to prevent ongoing loading of your spine in a particular way, such as changing your work setup so you don’t have to lift from the ground repetitively or altering your desk setup so you can sit or stand during the day to prevent stiffness and slumped spinal postures. And it is important to remember, that whilst you don’t have pain currently, factors that contributed to a back injury in the first place are likely to be the contributing factors in recurrence of an injury.
Sleep postures are vital in the care of your back as such a large proportion of your life is spent in bed. It is important to maintain a neutral spinal position, where your spinal is relatively flat and straight, to prevent unnecessary stress being placed on particular spinal segments. You should make sure that your back has appropriate support from your mattress and pillow and that these are replaced and turned regularly to maintain their optimal shape.
Exercise is a necessary long term part of treatment
Exercise is likely to be given to you as part of your treatment for your back injury and should become part of your long term management. This may include a combination of stretches and strengthening exercises which are required to maintain your spinal alignment and prevent you from reverting back to your previous posture and biomechanics. Clinical Pilates or specific gym exercises are a great medium for this, particularly in a supervised environment where your physiotherapist is able to monitor your posture and positioning at all times to gain the most benefit. Hydrotherapy is also a fantastic way to complete your rehabilitation due to the reduced weight bearing placing less impact on the affected areas and allowing greater flexibity in the warm water. By completing these structured programs the resistance, intensity and difficulty can be regularly monitored and adjusted for people at all stages of rehabilitation.
Seek early intervention if pain recurs
If you feel like your back pain is recurring it is important to seek early intervention. Your physiotherapist will be able to analyse your symptoms and resolve your pain much more quickly if you return earlier and have less associated tissue involvement.
Among patients with acute, low back pain presenting to an emergency department, neither the nonsteroidal anti-inflammatory drug (NSAID) naproxen combined with oxycodone/acetaminophen or the muscle relaxant cyclobenzaprine provided better pain relief or improvement in functional outcomes than naproxen combined with placebo, according to a study in the October 20 issue of JAMA.
Low back pain (LBP) is responsible for 2.4 percent of visits to U.S. emergency departments, resulting in more than 2.5 million visits annually. These patients are usually treated with NSAIDs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination. Pain outcomes for these patients are generally poor.
Benjamin W. Friedman, M.D., M.S., of the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y., and colleagues randomly assigned 323 patients who presented to an emergency department with nontraumatic, nonradicular LBP of 2 weeks’ duration or less to receive a 10-day course of naproxen + placebo (n = 107); naproxen + cyclobenzaprine (5 mg) (n = 108); or naproxen + oxycodone, 5 mg/acetaminophen, 325 mg (n = 108). Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP; naproxen, 500 mg, was to be taken twice a day. Patients also received a standardized 10-minute LBP educational session prior to discharge.
The researchers found that neither naproxen combined with oxycodone/acetaminophen nor naproxen combined with cyclobenzaprine provided better pain relief or better improvement in functional outcomes than naproxen combined with placebo. Measures of pain, functional impairment, and use of health care resources were not different between the study groups at 7 days or at 3 months after the emergency department visit.
Regardless of allocation, nearly two-thirds of patients demonstrated clinically significant improvement in LBP and function 1 week later. However, 40 percent of the cohort reported moderate or severe pain, half reported functionally impairing LBP, and nearly 60 percent were still using medication for their LBP 1 week later. By 3-month follow-up, nearly one-fourth of the cohort reported moderate or severe pain and use of medications for LBP. Three months after the emergency department visit, regardless of study group, opioid use for LBP was uncommon, with fewer than 3 percent of patients reporting use of an opioid within the previous 72 hours.
“These findings do not support the use of these additional medications in this setting,” the authors write.
1.Benjamin W. Friedman, Andrew A. Dym, Michelle Davitt, Lynne Holden, Clemencia Solorzano, David Esses, Polly E. Bijur, E. John Gallagher. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain. JAMA, 2015; 314 (15): 1572 DOI: 10.1001/jama.2015.13043
The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one-third of American adults and nearly 12 percent of children use alternative medicine – with back and neck pain being the top reasons for treatment.
Results of the 2007 survey of more than 32,000 Americans were released December 11 by the National Institutes of Health’s National Center for Complementary and Alternative Medicine.
According to APTA, physical therapy offers an evidence-based, time-tested solution to these common conditions in comparison to alternative treatments.
For neck pain, for example, a recent study published in the medical journal Spine found that when patients received up to six treatments of manual physical therapy and exercise, they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.
“This study, demonstrating the efficacy of physical therapy for a condition as widespread as neck pain, is particularly relevant in today’s challenging economic environment,” according to the study’s lead researcher and APTA spokesman Michael Walker, PT, DSc, OCS, CSCS, FAAOMPT. “The Kaiser Foundation, for instance, recently found that more than half of all Americans are not taking prescribed medication and postponing needed medical care in an effort to save money. It is important for consumers to know that there are effective, conservative solutions such as physical therapy available.”
Walker’s study compared the effectiveness of a three-week program of manual physical therapy and exercise to a minimal intervention treatment approach for patients with neck pain.
Study participants consisted of 94 patients with a primary complaint of neck pain, 58 (62%) of whom also had radiating arm pain. Patients randomized to the manual physical therapy and exercise group received joint and soft-tissue mobilizations and manipulations to restore motion and decrease pain, followed by a standard home exercise program of chin tucks, neck strengthening, and range-of-motion exercises. Patients in the minimal intervention group received treatment consistent with the current guidelines of advice, range-of-motion exercise, and any medication use prescribed by their general practitioner. Patients did not have to complete all six visits if their symptoms were fully resolved.
Sample exercises to relieve neck pain can be found on the APTA Web site, http://www.apta.org/consumer.
Results show that manual physical therapy and exercise was significantly more effective in reducing mechanical neck pain and disability and increasing patient-perceived improvements during short- and long-term follow-ups. These results are comparable with previous studies that found manual physical therapy and exercise provided greater treatment effectiveness (Hoving et al, 2002) and cost effectiveness (Kothals-de Bos et al, 2003) than general practitioner care.
1.Hoving et al. Manual Therapy, Physical Therapy, or Continued Care by the General Practitioner for Patients With Neck Pain. Ann Intern Med, 2002;136 DOI: (10):713-722
2.Bos et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial * Commentary: Bootstrapping simplifies appreciation of statistical inferences. BMJ, 2003; 326 (7395): 911 DOI: 10.1136/bmj.326.7395.911