By Lindon Beh, Physiotherapist
Types of Back Injuries & How to Manage BACK Pain
Back Injuries: Can Physiotherapy for Back Pain Help?
Back injuries are common. The majority of the population (4 out of 5 adults) will experience back pain or injury at some point in their lives.
The spine extends from the neck down to the tailbone and is made up of a long row of segments of bone known as vertebrae, which are separated by intervertebral discs and surrounded by ligaments, tendons and muscles.
The spinal cord is a bundle of nerves which sits inside the spinal column. The spine supports the body to sit, stand and walk and there are few tasks which don’t involve movement of the spine!
Injury can occur to any of the spinal structures and the type of injury may not always be reflected by the severity of pain experienced. Age, lifestyle, fitness level and type of work all have a big impact on spinal injuries.
The pain experienced can also vary widely depending on the individual and personal experience. Back injuries can be classified as acute or persistent and the specific type of injury helps dictate the most effective back physiotherapy treatment.
Acute back Injury
Some back injuries are acute, occurring suddenly after a specific type of movement, knock or fall resulting in pain. Acute back injuries may last for a few days or weeks.
Persistent back Injury
Persistent back injuries may build up gradually over time or they may stem from an acute injury where back pain or discomfort is still experienced after 12 weeks.
Common Types of Back Injuries
The back is a highly complex and integral part of the human body, which can unfortunately result in a wide range of injuries.
- Sprains & Strains
A small tear to ligaments, tendons or muscles may occur in the back. These injuries generally occur from high force/fast activities or when you are lacking capacity (strength and endurance) in the region. All sprains and strains are acute incidences, there is an exact moment when you feel something ‘go, pull, click’ etc.
Common mechanics of sprains and strains include pulling in an awkward position or pulling a heavy object off the ground ballistically.
In an awkward position (eg. in the back-seat of a car or narrow area) the back muscles are not in an optimal position or length to produce adequate force consistently. Constantly using the back in a compromised position may cause a sprain/strain.
In ballistic movements there may be more of a ‘yanking/jerking’ motion rather than a controlled lift. The ‘yank/jerk’ may have too much slack in the back musculature, and the sudden high speed activity produces too much force causing the strain/sprain.
Strains and sprains may also occur when your back muscles are fatigued. For example you may have 2 days of heavy gardening or renovations. You may get through the majority of the activities then feel a pull sensation late on day 2 whilst picking up a heavy can of paint. This is because the tasks have exceeded the back’s capacity/endurance.
If you have a strain or sprain you may feel an acute click, pop or pull sensation in the lower back region. Pain is generally on one side. Most lower back movements can be sore such as bending forwards, backwards and to the sides.
- Traumatic Injury
Sudden injury to any part of the spine, ranging from a minor injury which resolves on its own, to a major injury severely impacting spinal function.
- Herniated or Prolapsed Discs
Between the bony vertebrae lies a vertebral disc. Discs are fantastically strong, robust and durable structures that help with force distribution and load absorption along the spine.
Discs may become inflamed and/or protrude out of their position if they become overloaded. This may cause adjacent inflammation to the nerve roots or physically impinge the nerves exiting out of the spinal cord (nerve impingement).
This may cause a referral pain into the hips, glute, hamstring, calf foot. The referral pain is crudely labelled ‘sciatica’ and may create sensations of tingles, burning, electric shock or numbness sensations. Sensation and power may be reduced in some cases. The majority of disc injuries hurt to bend forwards (spinal flexion), with bending range reduced.
Disc injuries are very common and feel a lot scarier than they actually are, due to the referred pain in other areas and sharp pain on the back. It must be strongly emphasised that almost all disc injuries naturally recover!
Only a handful of cases would need further management from injections or surgery.
- Intervertebral Disc Degeneration
The intervertebral discs provide cushioning between the vertebrae, and degeneration means that a disc is narrowing and losing its sponginess. This can lead to back discomfort in the region of degeneration, or referred pain in a different region such as the hips.
- Sciatica
Pinching of the sciatic nerve which can be caused by a narrowing of the spinal canal. This results in discomfort down the outer buttock and down the legs.
- Spondylolisthesis
When a spinal vertebrae shifts anteriorly in relation to the rest of the spinal column, which can cause pain to surrounding nerves. This is often seen on scans, though causes nil to minor discomfort unless it is very significant movement.
- Stress Fracture
Lumbar stress fractures occur from training error.
The pars interarticularis is a small bridge of bone that becomes overloaded, with a bone stress injury or bone stress fracture, when high sporting loads are performed with inadequate recovery.
Lumbar bone stress injuries tend to occur in skeletally immature bodies ie. adolescence or young adults. They are most common in sports where there are high forces in lumbar extension (the back arching backwards) and lateral flexion (lumbar back tilting to one side). These sports include cricket fast bowling, gymnastics and running (both distance and sprints).
Pain may start as a dull ache and build to an intense ache or sharp pain. Lumbar extension becomes painful as well as awkward positions such as going in and out of a car or low couch.
These injuries are best diagnosed with an MRI.
- Scoliosis
Abnormal curvature of the spine which often develops with age, can cause back pain and structural abnormality of the spine. Scoliosis may be genetic or may develop with time.
Physiotherapy Treatment for Low Back Pain
Physiotherapists work with individuals on a one-on-one basis in the treatment of back injuries and pain, as all injuries and individuals are unique and have different contributing factors.
Physiotherapy for back pain involves careful assessment of the injury, direct treatment and the development of exercise programs tailored to the specific needs of each individual they treat. This involves strengthening exercises for abdominal and back muscles, which are important structures which support the spine.
Physically active individuals and those who maintain a healthy weight are at a lower risk of back injury. This combined with periodic back physiotherapy can help prevent back injuries from occurring in the first place.
Bed rest is no longer considered as an effective treatment for back pain, and inactivity can lead to the pain getting worse and reduced flexibility!
Keeping active after an injury is important.
Strain/Sprains Treatment for Low Back Pain
Physiotherapy may involve manual therapy such as massage, dry needling and mobilising joints to help settle pain and improve mobility. Once the pain settles mobility exercises will be introduced to restore movement. Then the strain region will be strengthened to restore previous strength
Finally physiotherapy rehab involves globally strengthening the back and surrounding regions to prevent future injuries.
Disc prolapse/inflammation Physiotherapy Treatment Melbourne
Physiotherapy may involve restricting forward flexion with taping or a brace. In very painful situations anti-inflammatories over the counter, or recommended from a GP or pharmacist may be beneficial to decrease the pain and inflammation.
Once the pain becomes bearable physiotherapists may use manual therapy such as massage, dry needling and mobilisations to improve mobility
The second phase of a disc prolapse injury involves strengthening up the lower back and the surrounding tissue to prevent future injury.
Lumbar Bone Stress Injury Physiotherapy Treatment Melbourne
Lumbar Stress fractures need an MRI to confirm the diagnosis. Often a sports doctor is involved in management to screen for contributing factors including diet, hormonal function and bone density.
Unfortunately lumbar bone stress injuries need a period of full rest. This may be 4-6 weeks of a good deload, and then general exercises such as increased walking and bike riding may be introduced. Strength training occurs soon after and is vital to improve on the surrounding musculature to better absorb forces rather than the spine.
Lumbar extension is then slowly introduced and a return to sport is gradually weaned up. A repeat MRI is often beneficial in an adolescent to ensure full bone healing has occurred.
Typically lumbar bone stress fractures take a minimum of 12 weeks to recover, cricket fast bowlers are slower at around 16-24 weeks minimum.
How Physiotherapy Can Help
Physiotherapists work with individuals on a one-on-one basis in the treatment of back injuries and back pain. Physiotherapy for back pain involves careful assessment of the injury, direct treatment and the development of exercise programs tailored to the specific needs of each individual they treat.
This involves strengthening exercises for abdominal and back muscles, which are important structures which support the spine.
Physically active individuals and those who maintain a healthy weight are at a lower risk of back injury. This combined with periodic back physiotherapy can help prevent back injuries from occurring in the first place.
Melbourne Sports Physiotherapy
Melbourne Sports Physio has a range of qualified and experienced professionals who can help provide ongoing support and treatment. Our friendly team are located in physio clinics across Melbourne in Essendon, North Melbourne and Blackburn South, and appointments can be made by calling 03 9498 0205 or booking online.
References
- https://www.spine-health.com/conditions/chronic-pain/types-back-pain-acute-pain-chronic-pain-and-neuropathic-pain
- https://www.braceability.com/blogs/info/back-pain
- https://www.spine-health.com/blog/understanding-different-types-back-pain
- https://www.healthination.com/health/what-is-back-pain
- https://www.webmd.com/back-pain/guide/pain-management-back-pain#1
- https://medlineplus.gov/backinjuries.html
- https://www.healthdirect.gov.au/back-injuries