What can be done to relieve my symptoms?
Physiotherapy can be very effective to ease your current pain and get you back to your normal everyday activities. Physiotherapy has been proven to be effective in both acute and chronic back pain. Physiotherapy can assist patients of all ages as well as all stages of back pain, whether this is your first bout of pain or whether you have had several bouts and you are dealing with chronic pain. Physiotherapy can also help by educating you about how to prevent back pain flare ups in the future.
Although the time required for rehabilitation varies among patients, you should expect to engage in therapy for anywhere from 3 weeks to 4 months depending on if your problem has occurred for the first time or is a chronic issue for you, and depending on how painful and limiting your problem is.
Fortunately, although back pain can be scary and debilitating, it is very rarely a sign of a dangerous problem or serious tissue damage. In most cases, back pain responds very well to physiotherapy treatment. Each of our treatments are designed specifically for your individual types of back pain and work to ease your pain and to improve your mobility, strength, posture, function and perception of vulnerability. In addition, your physiotherapist at Apex Physiotherapy and Health Clinics will teach you how to control your symptoms and how to protect your spine for the years ahead.
If your back pain is in an acute flare of less than 2-3 weeks, your physiotherapist may initially use ice, heat, ultrasound, electric muscle stimulation, interferential current, laser, needling, or hands-on treatment to address your symptoms. These modalities may be particularly helpful in the early weeks to improve your comfort so you can more easily engage in your physiotherapy regime and get back to your normal activities. Pain education will be a big feature right from the start to help you understand the nature of your back pain, address your fears or beliefs about back pain, and give you a sense of your prognosis to improve self-empowerment and reduce the likelihood of developing chronic pain.
Your physiotherapist will teach you ways to position your spine for maximum comfort while you recover from your injury or flare up. Your back is designed to withstand a variety of postures and it is actually healthy for your back to frequently move into many different postures. As long as you are without pain at the time, slouched sitting and lifting items with a slightly rounded back are ok for your back! In fact, the back is designed such that the anatomical structures that support your spine can still work efficiently in these postures. You and your physiotherapist may explore your preferred directions of movement and how to use them to your advantage early on as you heal. As rehabilitation progresses, it will be very important to explore and practice all directions of movement, and your therapist will guide your individual journey to movement freedom. Your physiotherapist will also explore efficient sitting, standing and movement postures and techniques to help you rediscover the strength and resilience of your spine.
You may be tempted to stop all activity because of your back pain however there is a great deal of evidence that shows that aerobic exercise (walking, running, biking or anything that gets our heart rate up) helps in the treatment of back pain and that increased overall fitness also reduces the risk of developing back pain again. Having moderate to severe pain with activity should always be respected but some mild discomfort may occur as you start back into your activities and as your back recovers and gets used to taking on load again; this is ok! This ongoing mild discomfort as you begin back to activity does not mean you are further injuring structures in your back. Some intense activities may need to be fully curtailed temporarily but gradually returning to your regular activity will be good for your back and your health in the long run. Your physiotherapist can help you to determine the best activities to restart and when to start them with your particular injury. They can also assist you in determining how hard you should push your activity level at each stage of your rehabilitation.
In addition to getting back to regular aerobic exercise, your physiotherapist will give you specific strengthening and stretching exercises to help your back. Your hip range of motion and strength is particularly important in helping your back function well so they will assess your hips and your lower body alignment and give you the best strength and mobility exercises for your individual needs in order to address any tightness, weaknesses and side to side imbalances.
Your ‘core’ muscles are those around your abdomen and trunk that help to maintain supple (not rigid) stability in this area and ensure efficient load transfer to the low back and entire spine. Maintaining adequate core strengthening is important in everybody, but particularly in those with low back pain. Some patients with chronic back pain unintentionally ‘overuse’ or inappropriately use their core muscles, and this can be more detrimental to someone with back pain than not using them at all! Your physiotherapist will check your core activation and strength and teach you how to appropriately and efficiently use your core muscles to support your spine in daily activities. A key feature will be teaching you how to move without holding your breath to allow you to load through your core efficiently and with less pain. Remember that your back is anatomically designed to withstand the loads of everyday life such as bending, twisting, jumping and taking load; your physiotherapist will educate you on how to ensure you are doing all the right things to optimize your back’s abilities.
If you have severe back pain, our physiotherapist may choose to work with you in a pool or encourage you to do exercises in a pool on your own. Physiotherapy done in water puts less stress on your low back, and the buoyancy allows you to move easier during exercise. Clients consistently report how much easier it feels to move their back when they are in the water.
It is well known that other factors can drastically affect your chances of getting low back pain and also how quickly you heal from your low back pain. As mentioned previously, people who smoke have both a higher chance of getting low back pain and recover from it more slowly as smoking decreases the blood supply to tissues and bones which leaves them vulnerable to injury, quicker to degenerate, and slower to heal. Your physiotherapist will encourage you to stop smoking if you do; even temporarily stopping while you are dealing with your back pain helps, but evidently quitting for good is recommended.
Fears, emotions, and beliefs also heavily influence the experience of back pain and the recovery trajectory. If you believe your back is unstable, fragile or degenerated it will be hard to trust movement is safe. If someone in your family has lived with horrible back pain, you may be inclined to believe that is your fate too and this can influence your experience. Furthermore, if you have experienced back pain and recovered from it, you may feel similar sensations and pains again if you experience emotional trauma, loss, anxiety or overwhelm. Your physiotherapist is aware of these factors and may do some additional assessments to determine if your pain is being created by the brain first, rather than in response to tissue damage. In either case, your physiotherapist knows the pain you experience is real and you are not making it up. Treatment approaches for centralized (or nociplastic) pain may be targeted at restoring your sense of safety, exploring your beliefs about your back pain in a non-judgemental way, and possibly getting you additional support to help process the emotional loads.
Being overweight can affect your low back, particularly if you carry your weight around your abdomen which indicates a higher body fat percentage and therefore higher systemic inflammation. If appropriate your physiotherapist will help support you to lose weight and modify your eating, sleep, and exercise, which will help you recover quicker and avoid future flare ups.
Physiotherapy at Apex Physiotherapy and Health Clinics will focus on reassuring you that swiftly getting back to work and other normal activities won't cause you harm and can actually help improve your back’s tolerance for activity in the future. Nonetheless, back injury flare ups may occur in the future and are often related to a period of emotional trauma, low mood, poor mental health, poor sleep, stress, inactivity, or trying a new activity; your physiotherapist will discuss what to do if your back pain returns and how best to manage this.
Your physiotherapist can also show you how to keep you moving with efficiency during routine activities. You'll learn about healthy postures for your back and using the best body mechanics to assist your back while lifting and carrying, standing and walking, and performing work duties. As mentioned previously, your back is anatomically designed to be strong and do many things such as carry loads, as well as to sit and to stand for periods of time. Contrary to popular belief, a slouched sitting position and allowing your back to bend forward slightly while lifting items is actually conducive to how your back is designed and is considered proper body mechanics! These positions allow the layers of long and tough ligaments and muscles at the back of the spine to mechanically do their job in supporting the spine. All this being said, however, our bodies in general are designed to move and not stay still in one position for too long, especially when recovering from injury. Your physiotherapist can advise you on how much is too much for carrying, sitting, standing and other activities as you recover from your back pain.
Although ‘bed rest’ was a common prescription in the past for acute back pain, ‘bed rest’ or lying down and doing nothing is rarely prescribed to help back pain these days. Alternatively, in cases of severe pain, your physiotherapist may suggest a short period of ‘modified rest’ where you are encouraged to rest in a comfortable position (such as on your back with your knees supported or in a semi-reclined position in a chair), but also still continue to do some modified activities, such as gentle hip and back range of motion exercises or light walking in order to keep your back moving while allowing your acute pain to settle. Again, staying in one position for too long, although comfortable at the time, is actually detrimental to healing. For this reason, modified rest after an acute injury will only be recommended for no more than 2-3 days.
A back support belt is sometimes recommended when back pain first strikes. In many cases a back brace can help provide support by adding compression to your back and increasing your confidence to move. A brace can lower the pressure inside a problem disc, decrease pain, and allow you to engage in some activities longer than you could without the back brace. Gradually your physiotherapist will encourage you to discontinue wearing the brace as your pain improves and you can engage in more advanced back strengthening exercises. Using the brace routinely after recovering from acute pain is not recommended. Wearing a back brace all the time after your back has recovered may cause muscles to atrophy and some patients will psychologically begin to rely on the belt instead of on the strength of their own muscles.
Your physiotherapist will suggest that you consult with your doctor or pharmacist regarding the use of pain relief or anti-inflammatory medication for your acute back pain. Although there is no medication that will cure low back pain, short term medications to combat pain, inflammation, and muscle spasm and to assist sleep can be incredibly useful to supplement your rehabilitation program. Over-the-counter medication is sufficient in most cases of back pain.
Apex Physiotherapy and Health Clinics provides services for physiotherapy in Abbotsford and Surrey.