Back pain, whether it lasts a day, a month, or a year, has most of us looking for a way out of it. While back pain is a common concern, the good news is that most back pain is self-limited and will resolve with conservative care.

1. OH! MY ACHIN’ BACK
GOT BACK PAIN ?
Back pain, whether it lasts a day, a
month, or a year, has most of us looking
for a way out of it. While back pain is a
common concern, the good news is that
most back pain is self-limited and will
resolve with conservative care. If you are
experiencing back pain now, though, you
are probably wondering what is causing it
and how you should approach treating it.
WH AT DO WE MEAN BY “BACK”
PAIN ?
When we talk about “back pain” we are
using a general term to refer to an area
that is quite complex and involves many
different structures. The spine itself
consists of bony vertebrae stacked atop one another that encapsulate the spinal cord
and provide tunnels through which the nerves of the spinal cord exit and travel to the
skin, muscles, bones, and organs. The back consists of many layers of muscles that
stabilize the spine and move the arms, legs, neck and spine. It also consists of fascial
tissue that surrounds muscles and organs and connects many areas of the body. Pain
or discomfort can arise from many or several of these anatomical layers.
When it comes to addressing back pain it is important to understand that while in some
cases, a specific anatomical structure may be primarily to blame such as a herniation in
an intervertebral disc or a strain of a specific muscle, oftentimes, the underlying cause
is nonspecific and due to faulty movement patterns or exceeding of the mechanical
stress threshold and your physical therapist will be evaluating how you move as much
as he or she is examining the structures of the back.
WH AT CAU S ES BACK PAIN
Back pain is often multifactorial and any or several of these processes may be
contributing to your symptoms:
Inflammation: inflammation occurs as a result of an acute injury or reinjury to the
structures in the back such as muscles or ligaments. It is both a necessary part of the
healing process and a common underlying cause of pain as the localized swelling and
chemical changes can irritate the sensory nerves in the area. It can also result from
other inflammatory conditions like an inflammatory arthritis.
Central sensitization: central sensitization refers to the increased responsiveness of
pain-sensing (nociceptive) neurons to normal or subthreshold input, meaning these
nerves interpret normally non-painful stimuli as pain. This is thought to contribute at
least in some part to the pain felt by chronic low back pain sufferers.
Radiculopathy: Radiculopathy is caused by narrowing of the space through which the
nerves of the spine exit. The underlying cause may be a herniated intervertebral disc, a
tumor, localized inflammation, or bone spurs causing narrowing of the intervertebral
space. Pain, weakness, or sensation changes that refer down into the buttocks or legs
is often radicular in nature
JANUARY 23, 2023
BACK PAIN GOT YOU DOWN?
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2. Fascial and soft tissue restrictions: The appropriate sliding and gliding of fascial layers
and soft tissue is important for normal, pain-free, and unrestricted movement.
Mechanical Back Pain: Mechanical back pain is the most common type of back pain
and occurs when a load is placed on a structure of the back (ie intervertebral disc, joint,
bone, muscle) that it cannot withstand and causes inflammation and irritation. This can
be acute such as an injury that occurs when you suddenly lift something heavy or
cumulative in response to something you’ve done over and over again.
WH EN S H OU LD I S EEK U RGEN T CARE?
Though back pain may feel very serious, it can often be managed in an outpatient
setting. In certain circumstances, however, back pain may signify a more serious
medical condition that needs urgent evaluation and treatment. Here are some red flags
to look out for:
• Back pain accompanied by losses of sensation in the trunk or lower body, changes
in bowel or bladder function or weakness in the legs needs immediate
assessment
• Low back pain that radiates to the abdomen and is characterized by a deep,
stabbing pain in the abdomen between the breastbone and the belly button could
indicate an abdominal aortic aneurysm. Suspicion for this condition is intensified if
there is a pulsatile mass that can be palpated or felt in the abdomen. Shortness of
breath, rapid heart beat, clammy skin, loss of consciousness, or anxiety may
indicate shock.
• Low back pain accompanied by numbness in the groin, genitals, buttocks, or inner
thigh and/or trouble controlling bowel or bladder function including difficulty
starting or stopping the flow of urine or feces or sexual dysfunction can indicate
cauda equina syndrome. This serious condition occurs when there is compression
of the nerves at the lowest part of the spine.
• Unrelenting back pain that is not responsive to medication or rest that is
accompanied by night sweats, fever, night pain, unexplained weight loss and
progressive weakness could be a spinal tumor or infectio
• Back pain after a trauma could indicate either soft tissue injury or fracture
Any one of these presentations necessitates urgent assessment by a medical
professional so that appropriate medical intervention and treatment can be prescribed
right away.
WH AT ABOU T PH YS ICAL TH ERAPY?
Physical therapy is a great option for treating new or recurrent back pain. Physical
therapy aims to give you immediate relief of your symptoms whenever possible, but
most importantly, aims to address the underlying causes to reduce the likelihood they
will return in the future. Here are some ways PTs will address your symptoms when
you come in for a physical therapy treatment:
Reduce pain, inflammation and irritation: While completely eliminating your symptoms
may take time, making you more comfortable in the meantime is an important first step
in your rehabilitation. Applying ice or heat, ultrasound or electrical stimulation to the
affected area can often give you some relief. Soft tissue mobilization or gentle joint
mobilization may also be employed by your physical therapist to reduce tissue irritation.
Improve flexibility: Your back PT program may include stretching, myofascial release
techniques, joint mobilization and mobility exercises to improve flexibility in the back
itself but also in other areas of the body such as the ankles, hips, and shoulders.
Build up your strength: You will learn exercises to help strengthen the muscles around
the back and abdomen to properly stabilize the spine and also in the arms and legs to
minimize excess strain transfer to the back. Having good strength throughout the body
allows stress to be distributed across multiple joints and helps to prevent injury and
irritation in the future.
Optimize your movement: Learning proper biomechanics and enhancing the
neuromuscular control of joints and muscles is an essential component of healing and
preventing back injuries. Physical therapists are movement experts and through
analyzing your movements, can guide you in improving how you move and train your
muscles to perform those movements in the safest and most effective way possible.
While back symptoms can be disruptive to your daily life, conservative treatments such
as physical therapy are often highly effective. Physical therapists can identify the
myriad of factors contributing to your specific back symptoms and provide you with a
rehabilitation program to improve them now and help prevent them in the future. A
physical therapist at Evolve can help you get on the road to healing your back.
Click here for more information about physical therapy for back pain in Brooklyn
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deal with the underlying issues, not just the pain itself.
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