BACK PAIN & WHAT THAT MEANS FOR YOU
There’s nothing simple about Simple Back Pain. Chronic, intermittent, persistent, niggly, sometimes with referral down the butt and thighs, sometimes back pain is brought on by nerve compression, poor posture, too much sitting, overloading, work and life stresses, and even past traumas. Let’s change the language of back pain and learn safe exercises with appropriate modifications to suit your situation.
Categories of Back Pain:
There’s nothing simple about Simple Back Pain. Chronic, intermittent, persistent, niggly, sometimes with referral down the butt and thighs, sometimes back pain is brought on by nerve compression, poor posture, too much sitting, overloading, work and life stresses, and even past traumas. Let’s change the language of back pain and learn safe exercises with appropriate modifications to suit your situation.
Categories of Back Pain:
- Acute back pain: Sudden pain that usually lasts a few days to a few weeks. It's often caused by an injury or accident.
- Subacute back pain: Pain that can come on suddenly or over time and lasts 4 to 12 weeks.
- Chronic back pain: Pain that lasts longer than 12 weeks and occurs daily. It can come on quickly or slowly and can make everyday activities difficult.
- Sprains and strains: Can occur when you pull a heavy object or pull in an awkward position. You might feel a pop, click, or pull in your lower back, and pain is usually on one side.
- Sciatica: A symptom of nerve pain in the back that occurs when something presses on a nerve root in the lower back. It can cause pain and numbness that stretches from the buttocks to the feet.
- Osteoarthritis: The most common type of arthritis, which usually occurs in older people.
- Ankylosing spondylitis: A type of arthritis that can occur in young adults and causes pain and stiffness in the lower back.
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Common causes:
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LOOSEN YOUR BACK - PREVENTING BACK PAIN
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TYPES OF BACK PAIN WE MIGHT SEE AT THE CLINIC
1. Flexion dominant back pain
Often, this type of back pain is described in terms of injury to the disc (though this is not always the case).
Signs & Symptoms:
Management:
2. Extension dominant back pain
Extension Dominant pain is often described in terms of the joints at the back of the spine called the zygapophyseal joints (or Z-joints). Again, this is often part of the problem, but not always. Extension Dominant pain has a tendency to follow an identifiable pattern.
Signs & symptoms:
Management & Exercise:
3. Neurogenic claudication
Neurogenic Claudication is a specific type of Extension Dominant back pain that tends to affect older individuals (60+). It’s caused by the nerves being compressed when the patient is standing and walking, and can significantly limit a patient’s ability to walk for long distances.
Signs & Symptoms:
Management & Exercise:
4. Inflammatory back pain
Inflammatory back pain is less common than mechanical back pain but is often misdiagnosed. This type of pain is caused by excessive inflammation in the spinal joints, secondary to a medical condition causing the immune system to attack the joints of the spine. An example of a condition that causes inflammatory back pain is ankylosing spondylitis. However, there are a number of conditions that can result in inflammatory back pain.
Inflammatory back pain will usually be diagnosed by a rheumatologist followed by medical management of any symptoms.
Signs & symptoms:
Management & Exercises:
5. Chronic pain disorders
A Pain Disorder involving back pain is one of the more challenging conditions for medical professionals to treat. The nervous system is interpreting stimuli not normally painful or harmful to the body as dangerous, which the brain then treats as painful. It’s a complex issue requiring a profound understanding of the patient, and what has led them to this place.
It can be incredibly frustrating for patients when medical professionals repeatedly tell them they see no organic cause for their pain. It’s important to note the pain these patients feel is just as physically real as it is for those suffering from a mechanical injury. The usual treatments don’t help these patients. They are best served by working with a multidisciplinary healthcare team, including a Remedial Massage or Myotherapist, Physiotherapist, Osteopath or Exercise Physiologist, with a strong understanding of pain science.
Signs & symptoms:
Management:
People suffering from a pain disorder will often experiment with pain relieving techniques to find a combination that works for them. We can help these clients to better understand their pain and guide them to maintain physical fitness and function. It’s also important to look out for any complicating factors, like anxiety, depression or past trauma, that may be contributing to the problem. These issues should be referred to a psychologist or counsellor for further management. Pain disorders of this nature are less common.
Consider changing your language when it comes to pain. Is it actual pain where your body is warning you that something dangerous is happening or is it exercise discomfort due to increased effort? People who have experienced chronic pain can often mislabel the sensation they are feeling as pain, especially if they are very deconditioned. Remind yourself that the movement you are doing is within safe range and that you are always in control of your body. Try not to hyperfocus on the movement or exercise. Consider working slow, gentle and easy without pressuring yourself to try something you aren’t mentally ready for.
1. Flexion dominant back pain
Often, this type of back pain is described in terms of injury to the disc (though this is not always the case).
Signs & Symptoms:
- Symptoms are made worse by sitting, bending, lifting
- Symptoms improve after standing and walking for short durations
- May include spine pain, leg pain or both
- May experience tingling/numbness
- Can progress to leg weakness
- Often has pain with cough/sneeze (but not always)
- Loss of range of motion (difficulty straightening up after rising from sitting)
Management:
- Manual therapy (Remedial Massage or Myotherapy in our case. Sometimes cupping or dry needling helps.)
- An ergonomic assessment of your workstation to ensure good posture or eliminate occupational risks
- Education on proper lifting and squatting mechanics
- Core muscle strength training (if weakness is an issue)
- Strengthening or stretching abnormally weak or tight hip muscles
- Strengthen weak glutes, stretch tight upper hamstrings
- Spinal mobility exercises in all directions
2. Extension dominant back pain
Extension Dominant pain is often described in terms of the joints at the back of the spine called the zygapophyseal joints (or Z-joints). Again, this is often part of the problem, but not always. Extension Dominant pain has a tendency to follow an identifiable pattern.
Signs & symptoms:
- Pain after standing for long periods
- Temporary relief from sitting or bending
- Range of motion is typically stable and does not change in short periods of time
- The back may be stiff, but it is always stiff in the same way
- Pain after high impact activities (running or gymnastics movements)
- Usually includes localized spinal pain
- May include leg pain, tingling, or even numbness in severe cases
- People who suffer this type of pain often stand with their low backs arched
Management & Exercise:
- Find ways to reduce pressure on the spine in extension
- Specific abdominal stabilizing exercises and hip mobility stretches (specifically hip flexor stretches) can be effective
- Intermittently using flexed postures to relieve pain is also helpful
- Pain relieving treatment techniques such as dry needling or cupping, or manual therapy (Remedial Massage or Myotherapy) may also play a temporary role
- Longer term care focuses on spinal/core strength and stability with good hip mobility
- Once pain is under control, the treatment program can be more aggressive. It will be aimed at building muscle around the spine while gaining length in shortened hip muscles
3. Neurogenic claudication
Neurogenic Claudication is a specific type of Extension Dominant back pain that tends to affect older individuals (60+). It’s caused by the nerves being compressed when the patient is standing and walking, and can significantly limit a patient’s ability to walk for long distances.
Signs & Symptoms:
- Typically no symptoms when sitting
- Upon rising and walking: pain, numbness or weakness in the legs begins after a predictable amount of time (length of time depends upon severity)
- Many of these patients have no local spine pain
- After symptoms begin, the patient must sit or bend forward to reduce symptoms
- Some patients are seen leaning over a shopping cart, for example, so they can walk without leg symptoms
- When patients with Neurogenic Claudication have an acute flare-up, their walking tolerance is greatly reduced
Management & Exercise:
- Take frequent breaks to allow your nerves to recover when acute flare ups happen
- Perform a variety of flexion-based stretches, and strategies to use throughout the day, and temporarily reduce walking distances
- As symptoms decrease, training and exercises to reduce pelvic anterior tilt in standing may be effective
- Remind yourself not try to ‘fight through the pain’ or ‘train’ yourself to walk further, which can aggravate the pain
- Improve abdominal strength so that you can walk without the spine falling into an arched or extended position
- Improve hip mobility so the pelvis isn’t pulled into an anterior tilt when standing and walking
- Build back strength and mobility
- Imagine lifting out of your lower back, stand tall
- Goal is to reduce sustained lumbar extension when walking
4. Inflammatory back pain
Inflammatory back pain is less common than mechanical back pain but is often misdiagnosed. This type of pain is caused by excessive inflammation in the spinal joints, secondary to a medical condition causing the immune system to attack the joints of the spine. An example of a condition that causes inflammatory back pain is ankylosing spondylitis. However, there are a number of conditions that can result in inflammatory back pain.
Inflammatory back pain will usually be diagnosed by a rheumatologist followed by medical management of any symptoms.
Signs & symptoms:
- Onset of pain is usually in patients under 35 years of age, and not due to trauma
- Pain persists for more than three months
- The back pain and stiffness worsen with immobility, especially at night and in early morning
- The back pain and stiffness tend to ease with physical activity and gentle exercise
- Anti-inflammatory medications (NSAIDs, such as ibuprofen or Naproxen) can be effective in relieving pain and stiffness in most patients.
Management & Exercises:
- Work with your instructor to find positions of relief, as well as activities to avoid when experiencing a flare up
- Keep exercises gentle, low impact and functional, focusing on maintaining mobility and pain reduction
- If your back feels better on the day with less pain, you may consider increasing the intensity of exercise but treat each day as they come
5. Chronic pain disorders
A Pain Disorder involving back pain is one of the more challenging conditions for medical professionals to treat. The nervous system is interpreting stimuli not normally painful or harmful to the body as dangerous, which the brain then treats as painful. It’s a complex issue requiring a profound understanding of the patient, and what has led them to this place.
It can be incredibly frustrating for patients when medical professionals repeatedly tell them they see no organic cause for their pain. It’s important to note the pain these patients feel is just as physically real as it is for those suffering from a mechanical injury. The usual treatments don’t help these patients. They are best served by working with a multidisciplinary healthcare team, including a Remedial Massage or Myotherapist, Physiotherapist, Osteopath or Exercise Physiologist, with a strong understanding of pain science.
Signs & symptoms:
- Vary widely
- Pain does not follow typical anatomic boundaries
- Location of pain may migrate to include other parts of the body
- Pain can be made worse by a state of anxiety or depression
- Increases and decreases in pain are not necessarily linked to mechanical trauma or physically stressful events
Management:
People suffering from a pain disorder will often experiment with pain relieving techniques to find a combination that works for them. We can help these clients to better understand their pain and guide them to maintain physical fitness and function. It’s also important to look out for any complicating factors, like anxiety, depression or past trauma, that may be contributing to the problem. These issues should be referred to a psychologist or counsellor for further management. Pain disorders of this nature are less common.
Consider changing your language when it comes to pain. Is it actual pain where your body is warning you that something dangerous is happening or is it exercise discomfort due to increased effort? People who have experienced chronic pain can often mislabel the sensation they are feeling as pain, especially if they are very deconditioned. Remind yourself that the movement you are doing is within safe range and that you are always in control of your body. Try not to hyperfocus on the movement or exercise. Consider working slow, gentle and easy without pressuring yourself to try something you aren’t mentally ready for.