Dear listeners, we continue our series on how physiotherapy can help with various problems. Today we will discuss back pain.

As is well known, the spine is divided into four sections – cervical (neck), thoracic (upper back), lumbar (lower back) and sacral (pelvic) segment. In one of our previous programs we discussed neck pain and headaches which are often associated with problems in the cervical spine. Today we will look at thoracic and lumbar spine pain. We will talk about common causes of pain as well as how to treat and prevent these issues.

We will first talk about the most common causes of back pain. Often pain is caused by a sudden injury, for example lifting something heavy, or sustaining a trauma during exercise. More often, however, the pain comes on gradually, as a result of load being repetitively placed on the intervertebral discs. These discs, which are located between the vertebrae of the spine, are responsible for absorbing shock and thus protecting the spine. Sitting, bending and twisting place the most load on the discs.

Let's say you have a sedentary job, for example you are in IT. Regularly sitting in front of the computer places a repetitive load on the intervertebral discs, resulting in back pain. But what if you have a physical job? Regularly lifting heavy weights will also place a load on the intervertebral discs. Even though the mechanism of injury will be different from a sedentary job versus manual labour, the end result is the same – load being placed on the discs. It’s also worth noting that to place a load on the discs you don’t have to do manual labour or have a sedentary job – this will happen even if you just spend a significant amount of time sitting on the couch in front of a TV. Similarly, even if you are retired now, but in the past you had a physical job, the back pain may well be the result of your work.

So, what do you do if you are experiencing back pain? The first step is to make sure that you have an accurate diagnosis. Your physiotherapist will be able to do this by gathering specific information about your condition as well as performing a thorough diagnostic assessment which will involve looking at your posture, the mobility of the spine and doing some other specific tests. If necessary your physiotherapist will also recommend for you to have further investigations, such as an X-Ray, CT scan or MRI.

Once the diagnosis is confirmed your physiotherapist will recommend the most effective treatment for your case. In our practice we always try to reduce the pain and inflammation first and then provide the patients with a specific home exercise program. This program is directed at improving the core strength, posture and general muscle strength. In order to reduce the pain we regularly use general physiotherapy, including soft tissue massage and mobilisations, as well as electrotherapy, therapeutic ultrasound, SCENAR therapy and drug phoresis.

As soon as the pain is under control the focus shifts to the exercise program. This is an essential part of the recovery process as the exercise program really aims at preventing recurrences. As mentioned previously the main muscles we try to strengthen are the core muscles, postural muscles and muscles of the legs. Real Time Ultrasound is very important in assessing the core muscles. This is the only way to make sure that you are engaging the muscles correctly as both yourself and the physiotherapist will see the movement on the screen.

Besides doing the home exercise program we highly recommend Clinical Pilates to our back pain patients. As discussed in one of our previous programs Clinical Pilates is very effective at improving the posture, strength of the core muscles and building up general muscle strength and tone. The program is prepared following a thorough full body diagnostic assessment which involves an assessment of the posture, the mobility of the spine and joints, muscle strength, ligament integrity and other factors. This ensures that the program is specific to each individual. In our practice we have seen very good results using Clinical Pilates as a treatment modality for back pain. Added benefits include improved balance, reduced likelihood of falls and better body shape. Your physiotherapist will also discuss correct ergonomics as relevant to your job, such as how to correctly sit in front of the computer and lift heavy items. This will also help to prevent recurrences.