BACK & SPINE

Overview:

Low/Mid Back and Spine:  If you suffer from low back pain, you’re not alone. Estimates show up to 80% of adults experience low back pain at some point in their lives. The direct medical cost and indirect costs (lost productivity, missed work) associated with low back pain make it the 3rd most burdensome condition in the U.S. in terms of mortality and poor health, behind heart disease and chronic obstructive pulmonary disease (COPD).

The lower back (lumbar) area is most commonly affected in the general population, although the mid-back (thoracic) region can also be affected. The lumbar region of the spine supports most body weight. It can be compromised by age, activity level, body mechanics, posture, genetics, occupational hazards, weight gain, pregnancy, and mental health issues. Some of these contributing factors can be addressed, while others cannot. Physical therapy plays a key role in:

1. Preventing acute low back pain through patient education, workplace education, body mechanics education, and postural education.

2. Early treatment of acute low back pain through appropriate interventions such as monitored exercise/activity, joint mobilization/manipulation, and patient education. Additionally, patients benefit from alternative hands-on techniques, including instrument-assisted soft tissue mobilization, trigger point dry needling, and massage.

3. Educating and correcting poor movement patterns or body mechanics resulting in excessive strain on the spine and associated structures.

4. Encouraging an active and healthy lifestyle.

The spinal column and associated structures are complex and intertwined. From the pelvic junction to its articulation with the base of the skull, the spine provides the primary support for your body, allowing you to remain upright, bend and twist. Additionally, the spinal column plays a critical role in the protection of the nervous system. With 33 individual bones (vertebrae) stacked on top of each other, the spine is remarkably stable due to the hundreds of ligaments, muscles, tendons, and connective tissue that provide additional stability and support.

Common back/spinal conditions:

The vast majority of low back pain is mechanical, meaning a defined disruption in how the components in the back move and fit together. In some cases, low back pain is associated with spondylosis, which refers to the normal wear and tear of the spine and general degradation of the spinal components with age. A Foothills physical therapist will complete a comprehensive evaluation to determine the musculoskeletal causes of your back or spine injury.

 

Sprains and strains: 

These account for most acute episodes of back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in the tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can be painful.

Physical therapy treatment is focused on proper movement, encouraging activity in a safe and controlled environment, hands-on techniques such as joint mobilization/manipulation and trigger point dry needling, and patient education. Restoration of function and prevention of recurrence is the primary goal of physical therapy treatment.

 

Intervertebral disc degeneration: 

This is a common mechanical cause of low back pain, and it occurs when the usually rubbery discs lose integrity during the normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and lower back torsion. As the discs deteriorate, they lose their cushioning ability and flexibility. This can lead to dysfunction in the articulation between vertebrae in the spine, resulting in pain, loss of function, and spasms. 

Physical therapy treatment is targeted at reducing acute symptoms through activity, patient-specific exercises, hands-on techniques, and a focus on ongoing patient education in exercise, wellness, and body mechanics to avoid further injury.

 

Herniated or ruptured discs: 

This occurs when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain. A herniated disc can result in compression of a spinal nerve root, resulting in radiculopathy, and a central disc herniation can result in compression of the spinal cord itself. Bowel and bladder incontinence associated with a low back injury is a medical emergency, and immediate medical attention should be sought. 

Physical therapy for a ruptured disc is geared towards reducing symptoms and restoring safe and appropriate movement patterns and exercise. Treatment may sometimes include mechanical traction to create relief and reduce pressure on the impinged nerve root. Additionally, the therapist may have patients repeatedly move in specific patterns to relieve symptoms. This treatment is known as the McKenzie Method.

 

Radiculopathy: 

A condition caused by compression, inflammation, and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated/ruptured disc compresses the nerve root.

Physical therapy treatment will focus on the likely source of the radiculopathy. The therapist will work with the patient using exercise, patient education, and hands-on techniques to improve function and reduce symptoms.

 

Sciatica: 

A form of radiculopathy caused by the sciatic nerve’s compression, the large nerve that travels through the buttocks and extends down the leg’s back. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve pain and numbness, and muscle weakness in the leg because of interrupted nerve signaling. The condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.

Physical therapy treatment for sciatica aims for symptom resolution and centralization of symptoms (reducing pain, numbness, or tingling in the extremity). Treatment may include specific exercises, hands-on techniques, activity modification, and patient education.

 

Spondylolisthesis: 

A condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column. There are various grades of spondylolisthesis based upon radiographic findings.

Physical therapy treatment is dependent upon the degree of slippage and the symptoms that are occurring. Emphasis will be placed upon patient education, positioning, posture, activity modification, and core stabilization.

 

Traumatic injury: 

Injury from playing sports, car accidents, or a fall, can injure tendons, ligaments, or muscles and result in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.

Your physical therapy treatment will be geared towards restoration of function, correct movement patterns, patient education in positioning, and protection while your injury heals.

 

Spinal Stenosis: 

This is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and lead to leg weakness and sensory loss.

Physical therapy will involve patient education in proper positioning and activities and strategies to reduce symptoms. Proper exercise tailored to your specific condition is paramount.

 

Skeletal irregularities: 

This include scoliosis, a curvature of the spine that does not usually cause pain until middle age, lordosis, an abnormally accentuated arch in the lower back, and other congenital anomalies of the spine.

Your physical therapist will work with you to address muscular imbalances to promote activation of specific muscles and address faulty movement patterns that may or may not contribute to your condition.

 

Postural Dysfunction: 

Poor posture is a contributing factor in developing sub-acute or chronic musculoskeletal pain. Often, poor posture puts unnecessary strain on tissues surrounding the spinal column and, over the long term, can contribute to compensatory changes in the musculoskeletal system. Often, children demonstrate poor posture, and corrective exercises and treatment plans can be beneficial as early intervention to prevent long term dysfunction.

Physical therapy will focus on patient education, postural restoration, and patient-specific exercises to address muscle imbalances and posture.

 

Muscle Imbalances: 

A sedentary lifestyle has been associated with an increased incidence of back pain. Often, long-standing muscle imbalances in the system (core) between trunk extensors and trunk flexors develop, resulting in subsequent low back/mid back pain. Additionally, the associated lower extremity and hip musculature can play a role in low back dysfunction.

Physical therapy should be geared towards restoring correct movement patterns and muscle activation and balance. Patient-specific exercises and an active, healthy lifestyle are encouraged.

 

Non-mechanical low back pain:

It’s possible that there can be non-mechanical sources of low back pain. All are severe medical conditions that should be evaluated further by a physician. A physical therapist will ask questions and perform an examination to help rule out any non-mechanical conditions and refer to a specialist when in doubt.

• Infection: Infections can cause pain when they involve the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis.

• Tumor: Occasionally, tumors begin in the back, but more often, they appear in the back due to cancer that has spread from elsewhere in the body.

• Kidney Stones: Can cause sharp pain in the lower back, usually on one side.

• Cauda Equina Syndrome: As discussed previously, a serious but rare complication of a ruptured disc. It occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots, causing loss of bladder and bowel control. Permanent neurological damage may result if this syndrome is left untreated.

• Abdominal aortic aneurysm: Occurs when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally enlarged. Back pain can signal that the aneurysm is becoming larger and that the rupture risk should be assessed.

• Osteoporosis: A metabolic bone disease marked by a progressive decrease in bone density and strength, which can lead to painful fractures of the vertebrae

• Fracture: Whether back pain is related to osteoporosis, a fall, trauma, or otherwise, a fracture within the spinal column should be suspected and assessed. A good medical history should identify potential sources of a fracture and symptoms regarding non-mechanical back pain.