Back Slipped Disc
Bulged Disc, Disc Herniation, Disc Rupture
Your back may suffer an injury to the intervertebral disc that can have numerous terms describing mild to severe disc injuries. This article will hopefully explain the differences between the various descriptions used to variations of disc injuries.
What is a Bulging Disc?
A bulging disc injury is a common spine injury sustained to your spine’s intervertebral disc. It can occur in your lumbar spine (lower back), thoracic spine (upper and mid-back) or your cervical spine (neck).
A bulging disc commonly describes a slipped disc or a protruding disc. However, when the disc bulge is significant enough for the disc nucleus to come out of the annulus, it is known as a herniated disc. See diagram.
What is a Spinal Disc?
Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.
The outer section of the spinal disc is the annulus. It consists of multi-directional fibrocartilaginous fibre layers. That are all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus.
The degree of spinal disc injury varies considerably from mild disc strains or internal derangements, mild-moderate-severe disc bulges through to complete disc rupture and herniation of the nucleus through the annular wall.
The fluid component, or disc nucleus, in the disc centre, is like the caramel inside a bar of chocolate. It usually moves within the annulus, adjusting to the pressures placed on your spine.
However, if you injure the annulus, the wall weakens, and the nucleus can press outwards on the weakened disc wall, causing your disc to bulge outwards.
A disc bulge (commonly referred to as slipped disc) can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs.
What Causes a Bulging Disc?
When a bulging disc, disc herniation or disc rupture occurs, it is typically due to either:
- a pre-existing weakness in the annulus, or
- a sudden increase in pressure through the disc causing fibres of the annulus to tear.
You can group the causes of a spinal disc injury under three headings:
1. Accumulated Microtrauma
Repeated microtrauma over an extended period can lead to disc injury. The best example of accumulated micro trauma is poor posture.
Poor posture when sitting, standing and working, stresses your spine. Sustaining a slouching or forward bending of your spine leads to overstretching and weakness of the posterior fibrocartilage (or annulus) of the spinal discs. Over time, this leads to poor disc integrity and displacement of the disc nucleus fluid posteriorly. This displacement places your spinal joints and nerves under pain-causing pressure.
Your aim to continually maintain a good position includes regular postural change.
During your initial efforts to retrain a good posture, poor muscle endurance and posture awareness predisposes you to sag back into your old habits. In these instances, it is useful to note that supportive posture devices such as a lumbar roll, Basset spine support, kinesio taping or a back brace are available to help you maintain a lordotic curve to your lumbar spine during this transition phase.
You should regularly alter any sustained posture to allow your spine to move and remain healthy.
2. Sudden Unexpected Load
Sudden unexpected load to the intervertebral discs can also occur in traumatic situations, e.g. a motor vehicle accident. This excessive load may occur due to the nature of the sudden forces exerted through your body at the time of impact, and your body attempts to repel those forces.
Unexpected load or torsion of a disc can result in tearing of the annulus fibres and hence a disc injury. You should always lift any amount of weight using the correct postural lifting principles. Using poor lifting techniques, such as bending forward and pulling with your back may result in sudden and unexpected loading of the disc.
Ask your physiotherapist about these principles.
3. Genetic Factors
Spinal disc injury does have a genetic predisposition. The deficiencies discovered include a lesser tissue density and increased elastin component of the fibrocartilaginous fibres. These make up the annulus of the intervertebral disc. Other factors that may play a role could be environmental – such as excess abdominal fat, poor core stability, reduced lower limb strength, nature of occupation (e.g., heavy physical load versus light or no physical pressure).
Overall, genetic factors are mild to a moderate contributing factor in disc injuries, and if one does sustain a disc injury, it is rarely ‘genetic’. And you can’t change your genetics. All you can do is be more diligent in your back injury prevention.
Bulging Disc Symptoms
A bulging disc injury is suspected when your back pain is aggravated by:
- forward bending
- coughing or sneezing
Sciatica, leg pain, pins and needles, numbness or weakness, are commonly associated with more severe disc pathologies.
Altered bladder and bowel function can indicate a severe disc pathology, which should prompt immediate medical assessment.
How is a Bulging Disc Diagnosed?
Your physiotherapist or doctor will suspect a spinal disc injury based on the history of your injury and your symptom behaviour. Your physiotherapist will perform clinical tests to confirm a spinal disc injury and detect if you have any signs of nerve compression. The most accurate diagnostic tests to confirm the extent of your spinal disc injury are MRI and CT scans.
MRI scans often identify a disc bulge. X-rays do not show acute disc bulging. However, X-rays can show signs of chronic disc injury such as degenerative disc disease and disc narrowing.
Bulging Disc Treatment
Most minor and moderately bulging disc injuries are treated conservatively without the need for surgery. Torn fibres of the annulus will heal and the disc bulge to usually resolve fully. While this occurs, your bulging disc treatment centres on encouraging the fluid to return and remain in the centre of the disc. This rehabilitation keeps the torn fibres closer to one another and the structure of the annulus as healthy as possible.
Your physiotherapist will advise you on the best positions to stay in and may tape or brace your spine. They’ll also explain to you the postures to avoid, which can be detrimental to your recovery.
By maintain the disc fluid in the central position that you intend it to stay, you are helping Mother Nature to lay down its scar tissue optimally for an excellent long-term solution. Please remember that scar tissue formation will take at least six weeks, so the longer that you avoid aggravating postures, the better!
PHASE I – Pain Relief & Protection
Managing your pain is usually the main reason that you seek treatment for a bulging disc. In truth, it was the final symptom that you developed and should be the first symptom to improve.
You are managing your inflammation. Inflammation is the primary short-term reason for why you have suddenly developed bulging disc symptoms. It best reduced via ice therapy and techniques or exercises that unload the inflamed structures.
Your physiotherapist will use an array of treatment tools. They aim to reduce your pain and inflammation. These treatment modalities may include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage, gentle exercise and temporary use of a back brace. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II – Bulging Disc Exercises
As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
Your physiotherapist will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilise your spine.
Researchers have discovered the importance of your back and abdominal core muscle recruitment patterns. Standard recruitment order of your deeper muscles, then intermediate and finally, superficial muscle firing patterns are typically required to prevent back pain. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you, specific to your needs.
Your physiotherapist may recommend a stretching program or a remedial massage to address your tight or shortened muscles. Please ask your physio for their advice.
PHASE III – Restoring Full Function
As your back’s dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic and spine alignment and its range of motion during more stressful body positions and postures. They’ll also work on your outer core and leg muscle power.
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your function to allow you to return to your desired activities safely. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Recurrence
Back pain does tend to return. The main reason back pain recurs is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best activities for you to continue indefinitely.
In addition to your muscle control, your physiotherapist will assess your spine and pelvis biomechanics and correct any defects. It may be as simple as providing you with adjacent muscle exercises or some foot orthotics to address any biomechanical faults in the legs or feet.
General exercise is a vital component to successfully preventing a recurrence. Your physiotherapist may recommend pilates, yoga, swimming, walking, hydrotherapy or a gym program. These modalities all appear to help back pain. Exercise will assist your back pain relief in the long-term.
Bulging Disc Exercises
You physiotherapist will prescribe the best bulging disc exercises. They will consider your disc bulge location, size, neurological symptoms and the acuteness of your symptoms. Please follow their recommendations as they guide you from back pain and back towards your healthy life.
Fine-tuning and maintenance of your back stability and function are best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
Bulging Disc Recovery Time
Unfortunately, bulging disc injuries are usually not a quick fix. Most bulging disc injuries do take several weeks, or even months, to settle.
Bulging discs will also remain weak and vulnerable for at least six weeks, sometimes longer. However, the good news is that most bulging disc injuries will not remain painful for that period. These lingering back sufferers tend to be inadequately managed disc injuries in the early phase.
The best thing you can do for a suspected bulging disc is to seek professional advice. After your assessment, your back physiotherapist or doctor will be able to provide you with what they would anticipate is your bulging disc recovery time.
What Happens if a Bulging Disc Goes Untreated?
Even if you don’t seek professional treatment, nature will naturally attempt to heal your bulging disc. While professional spinal care may fast-track your recovery, most instances of mild bulging discs will heal naturally and may not require treatment. However, patients suffering from a bulging disc commonly seek quicker pain relief. In these instances, please seek out the professional advice of your trusted spinal healthcare practitioner.
When is a Professional Opinion Recommended for Bulging Disc?
1. Loss of Bladder or Bowel Function. There are some bulging disc cases where professional care is essential. In some cases, such as when you lose bowel or bladder control, it is deemed an emergency, and you may require immediate surgery. These bulges usually are very significant and affect your nerve control involving your bladder or bowels. You should go straight to your nearest emergency department in these instances.
2. Weakness in your limb muscles is a significant concern. If you experience arm, hand, leg or foot weakness, please seek prompt medical assessment.
3. The reduced or altered sensation is your next priority. Mild disc bulges can reduce your ability to feel things touching you, e.g. numbness or pins and needles. If you experience any of the above symptoms, you should seek professional assistance.
4. Referred Pain. Pain in your limbs, e.g. legs (sciatica) or arms (brachialgia) is usually a more significant injury that when experiencing only spinal pain. We recommend that you seek the professional advice of your trusted spinal care practitioner.
5. Spinal Pain. Interestingly, if you are only experiencing spinal pain, bulging discs are generally mild injuries and the most likely to rehabilitate quickly. Please adhere to low disc pressure postures and exercise accordingly. If in doubt, please seek professional advice.
Spinal Disc Surgery
Surgery is occasionally required. Surgery is an option when a conservative (non-operative) approach does not settle your leg pain. While surgery is usually a last resort, an exception is emergency decompression. Surgical decompression occurs when severe nerve compression is affecting the function of your bowel or bladder. Or, if you experience significant muscle weakness, e.g. foot slap or drop.
Persisting symptoms over six months may require the attention of a surgeon who specialises in treating back pain and sciatica. Please remember, if you have severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness, you may require emergency surgery. Please head straight to an emergency department.
FAQs about Bulging Disc Injury
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
Back Joint Injuries
Nerve PainNerve pain is pain that is caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the common type of pain that is due to an injury. This is known as nociceptive pain.
What Causes Nerve Pain?Neuropathic pain is caused by a problem with your nerves themselves, which sends pain messages to the brain.
What is Nerve Pain Symptoms?Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.
What Causes Nerve Pain?Various conditions can affect your nerves and cause nerve pain. Common sources of nerve pain include:
- Shingles (post-herpetic neuralgia).
- Trigeminal neuralgia.
- Diabetic neuropathy.
- Phantom limb pain following an amputation.
- Multiple sclerosis.
- HIV infection.
- Other nerve disorders.
Nerve Pain & Nociceptive PainYou can suffer both nerve pain and nociceptive pain simultaneously. Both pain types can be caused by the same condition.
Nerve Pain TreatmentNerve pain is less likely than nociceptive pain to be helped by traditional painkillers such as paracetamol, anti-inflammatories and codeine. However, other types of medicines often work well to ease the pain. Nerve pain is often eased by anti-depressant or anti-epileptic medicines. Please ask your doctor for more advice.
Pain LinksPain & Injury
Tens MachineWhat is a TENS Machine?
Pins and Needles - Paraesthesia
What Causes Pins & Needles?
A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.
Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can be a sign of permanent nerve compression. Please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically.
The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.
Common Causes of Pinched Nerves
The most common forms of nerve compression are in the spinal joints where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.
How Can You Fix "Pins and Needles"?
If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness" or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.
Youth Spinal Pain
Teenager Neck & Back PainTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions. Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
PelvisCommon Youth & Teenager Sports Injuries Common Youth Leg Injuries Common Youth Arm Injuries
Back Muscle StrainsBack muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury. More info: Back Muscle Pain
Ligament SprainsLigaments are the strong fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries, and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible. More info: Back Ligament Sprains
Bulging DiscsA bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs. The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as a slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs. More info: Bulging Discs
Bone InjuriesYou can also fracture your spine if the force involved is highly traumatic or you have a low bone density (e.g. osteoporosis). More info: Osteoporosis
Poor PosturePoor posture when sitting, standing or lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure. More info: Poor Posture
What Can Cause Severe Low Back Pain?A sudden injury most often causes acute low back pain. The most common injury sources are the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.
Warning Signs of a More Serious Back Injury?In these instances of neurological deficit, please urgently consult your nearest hospital, doctor or physiotherapist. The following neurological signs warrant prompt assessment:
- pins and needles (paraesthesia),
- numbness (anaesthesia),
- leg muscle weakness,
- altered reflexes,
- difficulty walking,
- loss of control of bladder or bowels.
Non-Musculoskeletal Causes of Low Back PainAlthough most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
What Causes Lower Back Pain?Researchers and spinal health care practitioners categorise lower back bain into the following categories: 1. Specific Spinal Pathologies (<1%) 2. Radicular Syndromes (5-10%)
- Radicular pain, e.g. sciatica
- Spinal Stenosis
Specific Spinal PathologiesSome conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include:
- spinal infections
- cancer (malignancy)
- spinal arthropathies (e.g. rheumatoid arthritis or ankylosing spondylitis)
- cauda equina syndrome
- spinal fractures.
Radicular SyndromesLower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to general practitioners.
Radicular pain (e.g. sciatica)The most common pinched nerve in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve). The following back injuries may cause radicular pain:
- Herniated disc (slipped disc)
- Facet joint sprain
- Degenerative disc disease
- Back ligament sprain.
RadiculopathyLumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your ability to walk.
Spinal StenosisSpinal stenosis is a slightly different condition and relates to the narrowing of the spinal canal. Spinal stenosis is usually more prevalent as you age.
Non-Specific Lower Back Pain (NSLBP)Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify sufferers of lower back pain with no specific structure injured. It is a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms. Fortunately, these conditions account for approximately 90-95% of lower back pain and can nearly always successfully rehabilitate without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.
NSLBP CausesThe causes of NSLBP are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries. Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (e.g. poor posture) are probably more common but also more straightforward to prevent. In these cases, positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain. Most commonly, NSLBP causes include back muscle strain or back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly your acute disc health and predispose you to the severe pain. The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.
What is Back Muscle Pain?Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes. The causes of pure back pain are numerous but roughly fall into the following categories.
Back Muscle StrainsMuscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems. Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor PosturePoor posture, when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, and this puts spinal joint muscles and nerves under pain-causing pressure or strain, that results in back pain.
Ligament SprainsLigaments are the durable, fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain. Awkward lifting, sports injuries and motor vehicle accidents are prevalent causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
What are the Symptoms of Back Muscle Pain?Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain. Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and spasm.
- Protective back stiffness.
- Sudden back pain onset.
How is Back Muscle Pain Diagnosed?Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain". X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain. Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence. Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Strain CausesWe do know that some people are vulnerable to repeated lower back sprains and strains. While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth! The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but are right next to the joint to control excessive slides and glides. When they don't work correctly, the joint can slide too far and strain its supporting ligaments. Ouch! That hurts. The good news is poor core stability can be easily corrected to prevent back pain. Please contact your physio for more information or to have your core activation accurately assessed. High-risk factors of back pain include:
- sudden forceful movement
- lifting a heavy object
- twisting the back
- coughing or sneezing
- prolonged sitting with poor posture
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.
What is Therapeutic Ultrasound?Therapeutic ultrasound is an electrotherapy modality which has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied. Therapeutic ultrasound may increase:
- healing rates
- tissue heating
- local blood flow
- tissue relaxation
- scar tissue breakdown.
How Could Ultrasound Help?Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.
Specific Ultrasound UsesMastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours. The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies. Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.
What is an Ultrasound Dose?A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all. Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.
How Does an Ultrasound Work?A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.
When Should Ultrasound be Avoided?Contraindications of ultrasound include:
- local malignancy,
- over metal implants,
- local acute infection,
- vascular abnormalities,
- active epiphyseal regions (growth plates) in children,
- over the spinal cord in the area of a laminectomy,
- over the eyes, skull, or testes
- and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
Lower Back Pain Treatment Guidelines?While lower back pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
PHASE I - Back Pain Relief & ProtectionManaging your back pain is the main reason that you seek treatment for lower back pain. In truth, it was the final symptom that you developed and should be the first symptom to improve. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage. A course of non-steroidal anti-inflammatory drugs such as ibuprofen may also help in this phase.
PHASE II - Restoring Normal ROM and Strength. Early Back Exercises.As your lower back pain and inflammation settles, your lower back pain may feel better. Still, you are more vulnerable to re-injury during this honeymoon period when you don't have pain, but your muscles and ligaments are weak. During this phase, your physiotherapist will turn their attention to restoring your normal lumbar spine motion. Plus they'll assess your muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern). Your physiotherapist may commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best back exercises for your specific needs.
PHASE III - Restoring Full FunctionDepending on your chosen work, sport or activities, your physiotherapist will aim to restore your back's function to allow you to return to your desired activities safely. Everyone has different demands for their lower back that will determine what specific treatment goals you need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon or be a fast bowler. Your physiotherapist will tailor your back pain rehabilitation to help you achieve your own functional goals.
PHASE IV - Back Exercises - Preventing a RecurrenceRecurrence of lower back pain can occur. The main reason for a recurrence is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal core muscle exercises. You should continue a version of these back exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best activities for you to continue indefinitely.
Suffering Back Pain. What Should You Do?While lower back pain is commonplace, the diagnosis of the cause of your back pain is specific to you, and therefore, the treatment or investigation pathway varies for each case. A spinal health care professional can assist you with a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to you. You should feel confident that your practitioner has screened you particular pathologies that require urgent medical attention. They should assess you for neurological deficits such as:
- loss of bowel or bladder function,
- leg muscle weakness,
- loss of sensation,
- diminished reflexes,
- and, day-to-day function.
What Should You Do When You Suffer Back Pain?
Rest?The latest research recommends that you only spend a day or two resting in bed. More extended periods cause muscle weakness which ultimately makes repeat back pain more likely.
Ice or Heat?We recommend ice treatment for 20 minutes every 2 or 3 hours for the first 48 hours. The ice should help reduce your pain, swelling and back spasms. After a few days, you are safe to use heat packs. We usually recommend avoiding heat (and heat rubs) in the first 48 hours. Heat packs encourage bleeding, which could be detrimental if used too early.
Should You Use a Back Brace?A back brace can help you to get back on your feet or allow you to return to work sooner. We don't encourage long-term use because research has shown that your stomach and back muscles will weaken as you become reliant on the brace.
What Medication Should You Use?Your Doctor or Pharmacist may recommend pain relief in the form of paracetamol or an anti-inflammatory. You are best seeking their advice as certain drugs can interfere with other health conditions.
When Should You Commence Physio?In severe cases, when the slightest movement causes unbelievable pain or spasm, it may be best to wait a day or two to start treatment. This delay will allow the majority of swelling to settle. Slight niggles or "my back feels out" sufferers can usually commence treatment (and maybe fixed) on the day of injury. If you are not sure what to do, please call us for advice. We'll happily guide you in your time of need.
What About Core Stability Training?The current trend in physiotherapy and fitness training is 'core stability training' (back and abdominal muscle control).
What If You Do Nothing?Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome and the quicker you'll get back to living your life."Back pain is something you could be suffering needlessly".
What Results Should You Expect from Physiotherapy?Not only will your physio diagnose the cause of your pain and give you the "peace of mind" associated, but they'll also help you to:
- Relieve your pain quicker
- Cope better with your pain using proven strategies and tips
- Get you back to work and play quicker through faster healing rates
- Loosen and strengthen your back with individually prescribed exercises
- Prevent future bouts of back pain via our holistic back pain management approach
Core ExercisesWhile all back exercises that strengthen the muscles that traverse your back are essential, back pain researchers have emphasised retraining your deep core muscles as a priority. "Core Stability" is your body's ability to control and support your spine via specific muscles dynamically. Your spine is an inherently unstable area of your body. Your lower back has five vertebrae that allow twisting, bending and arching with no other bones to assist. They sit on top of a triangular bone called the sacrum, which wedges itself into the pelvis. Unfortunately, without strong support, all of these bones would fall in a heap on the ground. Your deep core muscles are the main structures that support, control and move your lower spine and pelvis. They are also the most energy-efficient and best-positioned muscles to do the job for 24 hours a day. However, when they turn off, your spine is not fully supported by its usual muscular corset. This lack of support makes it quite vulnerable to injury and chronic pain. Research has shown that our back pain causes your "deep core stability" muscles to STOP working in EVERY case. The first time you experience low back pain, your brain automatically inhibits the regular activity of the Transversus Abdominis (TA) muscle. This inhibition occurs in 100% of sufferers. Unfortunately, even once the back pain has eased the TA muscle does not automatically switch on again. Inhibition of the TA muscle exposes your spine to further trauma and hence "recurrent back pain". Each incident becomes a little more severe, and consequently, further wasting of the TA occurs. Other causes of muscle inhibition include previous abdominal surgery, pelvic pain and post-pregnancy.
What are the Benefits of Core Stability Training?Researchers have shown that the correct use of your core stability muscles not only prevents pain but also alleviates pain if you're already suffering. Also, your body's strength, power, endurance and performance will improve. You'll be able to run faster, jump higher and even throw further when these muscles work correctly. For more information, please contact your physiotherapist.
Core Stability MusclesThe deep core stability muscles of the lower spine include:
- Transversus Abdominis (TA)
- Multifidus (MF)
- Pelvic Floor (PF)
Transversus AbdominisThe Transversus Abdominis (TA) is the deepest abdominal muscle. It is the "corset muscle" of the spine and pelvis. In the typical situation, TA contracts in anticipation of body motion to guard the spinal joints, ligaments, discs and nerves.
MultifidusMultifidus (MF) muscles are very short muscles running from the transverse processes (on the sides) of one vertebra up to the spinous process (the middle of the back) of the next vertebra upwards. Their primary function is back stability. They do not produce an extensive range of movement, but work to provide small, "fine-tuning" postural changes, all day long.
Pelvic Floor & DiaphragmThe TA and the MF work in conjunction with your pelvic floor and diaphragm to make a flexible but stable region around your lumbar spine. It is this ability to stabilise your lumbar spine in its many positions that enable you to overcome back problems and reduce your chances of a reoccurrence.
What Are The Ideal Core Exercises?Your deep core stability muscles retraining uses specific low-level activation exercises. While a very skilled physiotherapist who has training in deep core activation can observe and palpate for the correct muscle contraction, the best way is to see them working on a real-time ultrasound scan. Real-Time Ultrasound Physiotherapy guidance allows you to see how your muscles are contracting in real-time. This visual feedback will enable you to correct your specific deep core muscles inside your stomach, lower back, and pelvic floor as you attempt to contract those muscles.
Beware of “Core Stability” Exercises!The fitness industry is full of fitness instructors who profess to know how to activate your core stability muscles. Unfortunately, the wrong core exercises will do you harm. Most progress your core exercises far too quickly and bypass these critical muscles to strengthen your outer abdominal muscles further and leave your deep core muscles weak. Research evidence has found that this renders you vulnerable to lower back pain and injury.
How Good is Your Core Stability?Research clearly shows that core stability retraining has short and long-term benefits for low back pain sufferers. The good news is that we also know that core stability training markedly reduces your chances of re-injury. Research on lower back pain sufferers has shown us that if you can re-activate your core stability muscles, your chance of recurring back pain reduces. Your chances of not experiencing another bout of low back pain (LBP) within twelve months are almost three times better if you have undertaken an ultrasound-guided exercise program; 84% vs 30%. After three years, you still have a two in three chance of not experiencing low back pain if you did the exercises. Adding even more research support, if you didn't do the exercises, you only have a one in four chance of being pain-free. You're still over twice as likely to not experience another episode of back pain. Hides et al. (2001). PhysioWorks physiotherapists have professional knowledge in the training of core stability muscles. The difficulty has always been how to quantify a patient's level of stability control. That is, until now. The solution has been to develop a useful and clinically practical method of assessing your level of core stability. We can then determine and at what level it fails to cope when the demands placed upon your body. That is, what is the individual client's functional Back Stability Score (BSS)?
How Do We Assess Your Core Stability?Your PhysioWorks physiotherapist will assess you to determine your current symptoms, pathology and functional requirement. Then, they'll physically test you to decide on your back stability based your ability to activate your core control muscles (transversus abdominis, multifidus and gluteals). If you can isolate these muscles, we are then able to test further when your core stability muscles lose control of your spine, become inhibited or fatigue. This testing assists us in determining what tasks make you vulnerable to back pain or injury.
What Happens After Your Core Stability Score is Determined?Based on your functional needs, your treatment directs towards your specific areas of weakness. The result is a much stronger, stable and pain-free back. If you would like to know your Back Stability Score, please contact PhysioWorks.
What are the Benefits of the Functional Back Stability Score?
- You have a quantitative guide to your functional goals
- You have a current status score. Progress is measurable.
- You can progress quickly through the BSS levels to maintain motivation and self-esteem
- Individualised treatment. Different retraining options depending upon desired outcomes.
- You can self manage in long-term
- Your goals are functional (task-related) rather than merely a strength score.
- Quantitative Feedback for You, Your Health Practitioners and Insurers.
- Achieve stepped goals and sensible, steady exercise and treatment progressions.
- We'll educate you on how to prevent future injuries.
- You'll be introduced to ergonomics and understand the best postures for you
- You will prevent future bouts or at least minimise their severity
- It's a research-backed solution.
- It's perfect for all ages and physical ability.
- There is a clear path for progression.
- You perform your exercises in the comfort of your own home without expensive gym equipment or membership
- You'll have personalised professional guidance for assessment, reassessments and progressions.
- You'll be pain-free ASAP
For Clinicians & Insurers
- It's a precise measure of your functional capacity
- It allows better judgments on patient directions, e.g. returns to work
- It offers better-individualised advice and treatment
- It reduces jargon through measurable standardisation
- It's a practical measure that can be related to other outcome measures such as Oswestry Disability Score
- There is a clinically relevant correlation between subjective and objective findings
- It reduces malingering.
What Conditions Does the Back Stability Program Improve?
- Spinal Pain
- Spinal Posture
- Pelvic floor function
- Degenerative Disc Disease
- Poor Balance or Fall History
What Causes Back Pain?
Back pain is often the result of having weak stabilising muscles supporting your joints. Without strong support, your joints simply collapse. Your bony skeletons don't stand up by themselves. The bones are held upright by efficient, supportive muscles that work across every joint in your body.
Research has shown us that pain causes these supportive muscles (known as your "stabilisers" or "inner core stability" muscles) to stop working. Research on sufferers of lower back pain has found that these muscles stop working every time you experience back pain.
Even worse, in most cases, these muscles don't automatically start working again when your pain goes. They need to be deliberately re-started by your brain.
How Can You Reactivate Your Core Stability Muscles?
There are several ways to reactivate your core stability muscles. One of the most effective is to use a Swiss Exercise Ball. Usually, some simple Exercise Ball exercises can often automatically 'kick start' these stabilising muscles.
Your physiotherapist is an expert at the reactivation techniques of these stabilising muscles. For more advice, please contact your physiotherapist. Alternatively, you can download or eBook on Back Pain Rehabilitation using a Swiss Exercise Ball.
How Does a Swiss Exercise Ball Eliminate Pain?
Your Exercise Ball is an unstable surface. When you sit or exercise upon one of these balls, your body will automatically recruit your natural balance reactions. One of the critical most components of your balance reaction system is the activation of your stabilising muscles. With repeated use over just a few days, your stabilising muscles will automatically start working again in most cases.
Researchers have discovered that by merely activating the inner core stability muscles, you have two to three times less likelihood of recurring lower back pain.
What Can You Do?
If you want to fix your back pain, you can do something. The Exercise Ball could be just the solution you need to avoid future bouts of lower back pain.
Core Stability vs PilatesThe whole 'core stability' phenomenon started back in the 1920s with a chap named Joseph Pilates, who's exercise regimes have become quite trendy in the last ten years. Pilates talked about developing a 'girdle of strength' by learning to recruit the deep-trunk muscles. Even without complete knowledge of anatomy and the benefits of the latest muscle activity research, he was aware of the importance of these deep muscles and their supportive effects. Put simply; core stability training targets explicitly the smaller and deeper back and stomach muscles. Once recruited, these muscles control the position of the spine during dynamic movements of your body.
Is Pilates for Everyone?Sadly, No! Exercise programs that aim to develop your deep core strength can often do just the opposite. The most common reason for injury and back pain is the incorrect timing of core muscle recruitment. Pilates, Yoga, gym strengthening and other forms of exercise place high demands on your core stability system. Abnormal core muscle recruitment order increases your injury chance proportion with the exercise difficulty. Remember, if you build a tower on a weak foundation, it will eventually topple. Look what happened to the Leaning Tower of Pisa. It's got lousy core stability! The same goes for your core stability muscles. However, recruiting the deeper core muscles before your superficial layers just like adding floors to a sturdy skyscraper and your back will be healthy and pain-free forever.
Why is it Important to Specially Retrain your Core Stability Muscles?Once the core muscles become weak, and their timing is incorrect, you can experience prolonged back pain and are at much higher risk of re-occurrence. Research has identified that the order of core muscle recruitment is one of the most critical factors in the prevention or resolution of pain. Real-Time Ultrasound Physiotherapy has proven particularly useful to correct the muscle recruitment order. To solve your back pain and to reduce your re-injury risk, you must retrain these muscles back to an appropriate level for your needs. If you are relatively sedentary, you may only need a low level of control, however, if you are a high-level sportsperson or a manual worker you will need to work up to a much higher level of core strength.
What Should You Expect?In the initial stage, you need to be able to activate these muscles consciously and incorporate them into an exercise program. A lot of people find it difficult to isolate these muscles and need help to be able to activate them effectively. Research has discovered that real-time ultrasound-guided treatment is the most effective way to retrain an isolated and well-timed core stability contraction successfully.
Chronic Back PainIf you suffer back pain, you’ll know that it has a nasty habit of returning. Not only is it painful, but it can interfere with your work, sport or just everyday life. Acute back pain usually settles with conventional spinal treatment. However, the recurrence rate is extremely high. In fact, there’s an 84% chance of recurrence within one year! (Hides et al 2001)
Why Do You Keep Getting Back Pain?Researchers discovered that a couple of deep muscles in your abdomen and lower back need to contract to support your spine. When they work correctly, you’re much less likely to suffer back pain. The bad news is that these muscles turn off every time you suffer back pain and don’t automatically turn on again. This leaves your back at risk of injury. However, the good news is these deep muscles in your abdomen and lower back can easily be retrained. The most effective retraining method is via real-time ultrasound. The chance of lower back pain (LBP) recurrence within one year is reduced significantly.
Back & Neck Pain Prevention TipsHere's some very useful advice to help you prevent back pain and enjoy life to the maximum.
PostureI'm afraid that your mother was right. If you slouch you'll end up with problems. Just one of those problems is back pain. You'll find other problems elsewhere on this website. Think "Grow Tall". Imagine that you have a string screwed onto the back the back of your head, just above your hairline. Then think that someone is dragging you up off the chair you are sitting on. Hold this "grow tall" position for 10 seconds and repeat every half hour. As well as greatly reducing your chances of back pain you'll note that your chest has lifted, shoulders are relaxed, chin is tucked in, head is level and stomach muscles have contracted. Not bad for such a simple exercise. This posture can be repeated in sitting, standing, sleeping, walking or running. Try it and physio will work for you too!
LiftingThe best method to avoid back pain from lifting is delegation. If this isn't an option for you, try the following:
- Use a back support to lift loads over 15 to 20kg.
- Bend at the hips and knees with your feet shoulder-width apart.
- Firmly grip the load and hold it close to your body.
- Think "grow tall" to tighten your stomach muscles and look upwards to straighten your back.
- Stand using your strong thigh and buttock muscles to lift.
- Once upright, turn by using your feet. Avoid twisting your back.
SittingUse the "grow tall" principle each 15 to 30 minutes while sitting. A supportive chair or lower back cushion is essential if you must sit. If possible don't stay seated for too long. Regularly stand up, stretch your back and walk short distances for a variety of posture. We were, after all, designed to hunt and forage - not sit in front of a computer!
ExerciseFitness has many benefits. Stronger, more flexible muscles and less weight to stress the bones and discs. PhysioWorks specialises in the provision of exercise programs to keep your back flexible, strong and painfree. Exercise can involve aspects of flexibility, strengthening and postural control. Consider Real Time Ultrasound Retraining to ensure you are doing it right!
SleepingA quality pillow and mattress are necessary for a healthy spine. You do spend somewhere between one-quarter (1/4) and one-third (1/3) of your life sleeping. Do it in comfort! You'll need to consider a new mattress if you wake up through the night or in the morning with back pain. Please ask your PhysioWorks therapist for advice at your next visit.
DrivingUse the "grow tall" principle each 15 to 30 minutes while driving. The combination of sitting and bumpy roads are a recipe for back pain. A lower back cushion is essential if you must drive any distance. If possible don't stay seated for too long. Regularly break your travels to have a walk and perform simple stretching exercises for a variety of posture and a healthy spine. We were, after all, designed to hunt and forage - not sit in front of a computer!
Research FindingsResearchers discovered that smoking history, high blood pressure, and heart disease - all of which are risk factors for narrowing of the arteries - significantly increased the likelihood of low back pain. These same risk factors, along with high cholesterol levels, were also significantly associated with the development of lumbar spondylosis (degeneration).
Why?These findings support the theory that narrowing of the arteries may cause lower back pain and degenerative disorders of the intervertebral discs. Researchers have suggested that damage to the vascular structures (blood supply) of the discs and joints is the mechanism of injury in low back pain.
Conclusions from Smoking and Low Back Pain StudyThe study concluded that development of lower back pain was significantly associated with smoking history and high blood pressure, and the development of lumbar spondylosis was significantly associated with smoking history, and high blood pressure and cholesterol.
What about Diabetes and Lower Back Pain?The good news for diabetics was that diabetes did not increase the incidence of lower back pain or lumbar spondylosis (degeneration).
Back Pain ConditionsAnkylosing Spondylitis Back Muscle Pain Bulging Disc Core Stability Deficiency Cramps Degenerative Disc Disease DOMS - Delayed Onset Muscle Soreness Facet Joint Pain Fibromyalgia Lumbar Stress Fractures (Cricket Fast Bowlers) Muscle Strain Osteitis Pubis Osteoporosis Overuse Injuries Pinched Nerve Piriformis Syndrome Pregnancy Back Pain Rheumatoid Arthritis Sacroiliac Joint Pain Scheuermann's Disease Sciatica Scoliosis Side Strain (Abdominal) Spinal Stenosis Spondylolisthesis Spondylolysis (Back Stress Fracture) Spondylosis (Spine Arthritis) Stress Fracture
Back Pain FAQsCommon Physiotherapy Treatment Techniques What Causes Back Pain? What is Pain? Physiotherapy & Exercise Massage Styles and their Benefits What Causes Post-Exercise Muscular Pain? What are the Best Core Exercises? Can Kinesiology Taping Reduce Your Swelling and Bruising? Chest Pain: Is it a Heart Attack or Your Spine? Does Smoking or Diabetes Cause Lower Back Pain? Heat Packs. Why does heat feel so good? How Do You Prevent Back Pain? How Does an Exercise Ball Help Back Pain? How to Achieve the Best Standing Posture Lower Back Pain Research Posture Trainer? Check out the BackTone 4000 Sports Injury? What to do? When? What are Growing Pains? What are the Benefits of a Standing Desk? What are the Benefits of Good Posture? What are the Common Adolescent Spinal Injuries? What are the Common Massage Therapy Techniques? What are the Early Warning Signs of an Injury? What are the Healthiest Sleeping Postures? What are the Signs of an Unsupportive Pillow? What are the Symptoms of a Low Back Strain? What Can You Do To Help Arthritis? What Causes Pins and Needles? What Causes Repeat Low Back Strains & Sprains? What is a TENS Machine? What is Chronic Pain? What is Good Standing Posture? What is Musculoskeletal Physiotherapy? What is Nerve Pain? What is Sports Physiotherapy? What is the Correct Way to Sit? What to do when you suffer back pain? What to expect when you visit PhysioWorks? What's the Benefit of Stretching Exercises? What's Your Core Stability Score? When Should You Use a Shoulder Posture Brace? Why are Sprains and Strains of the Low Back Common? Why are Your Deep Core Muscles Important? Why does Back Pain Recur? Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
Lower Back PainLower back pain (LBP) is one of the most common conditions in health care. It is suggested that 80% of the population will suffer low back pain at some point in their lives. Lower back pain costs our country billions of dollars every year through absenteeism and injury rehabilitation. It is critical to all those who suffer from low back pain that a safe and effective treatment protocol be developed to beat lower back pain. Australian physiotherapists lead the world with groundbreaking research to improve the treatment and prevention of low back pain. At PhysioWorks, we are glad to offer both immediate pain relieving techniques and a longer-term preventative programs to stop recurring lower back pain.
How PhysioWorks Can Help Your Lower Back Pain?Well-designed research and highly skilled clinical practice has provided evidence for physiotherapy as a safe, effective and low cost management approach for low back pain. PhysioWorks' physiotherapists are highly skilled in the assessment, diagnosis and successful treatment of patients with low back pain arising from a musculoskeletal dysfunction. Our injury management involves not only 'joint manipulation' like some other health practitioners, but also less forceful but equally effective passive examination and treatment techniques, effective therapeutic exercise (strengthening and stretching) and vital advice on posture, lifting and movement pattern abnormalities. In other words, your physiotherapist will fix the immediate problem and then help you to stop it coming back using a multitude of techniques and skill. Call PhysioWorks Book Online
Evidence Based Physiotherapy for Low Back PainThere has been substantial research undertaken by physiotherapists investigating the techniques used. This research has been conducted according to extremely strict research guidelines. Unlike some alternative back pain remedies, physiotherapists base their treatment protocols on scientific research evidence. Based on a comprehensive review of the scientific literature the Australian Physiotherapy Association (APA), with assistance from the Musculoskeletal Physiotherapists Association (MPA), has developed a recommendation for the successful treatment of low back pain.
Low Back Pain - Acute (less than 3 months)There is considerable evidence to support that spinal manipulative therapy (SMT) including passive mobilisation and manipulation, McKenzie therapy and the encouragement of early active movement, rather than bed rest, is effective in the short-term management of low back pain. SMT provides better short-term improvement in both pain and the return to normal activity levels than the comparison regimens of traction, massage, short-wave diathermy and epidural injections. Compared to placebo or other conservative treatment, a recent meta-analysis reports twelve out of sixteen trials as favourable for SMT.
Chronic Low Back Pain - Greater than 3 monthsThere is strong evidence to support that exercise programs result in a faster return to work rate, reduced absenteeism and disability when compared to control groups. Your PhysioWorks' physios possess the necessary skills and education to individually assess each low back pain candidate and then appropriately design, prescribe, supervise and progress your successful low back pain exercise program. Currently, physiotherapists are pioneering research investigations into the mechanisms contributing to chronic and recurrent low back pain. The research evidence to support their efficacy is continually increasing. Spinal manipulative techniques (SMT) has been strongly shown to be more effective in the management of chronic low back pain than bed rest, pain killers and massage, with six out of eight trials supporting this evidence. More importantly, the combination of SMT and specific exercises has increasing support in the management of low back pain. Your PhysioWorks physio has the necessary skill and knowledge to provide you with optimal low back pain care.
Real-time Ultrasound Guided TreatmentThe best way to activate the correct core stability muscles is to actually see them working on an ultrasound scan. Yes, it's just like seeing an unborn baby. We now have this fantastic technology at several of our PhysioWorks clinics.
- Real Time Ultrasound Physiotherapy
Electrical StimulationThere is no harm in applying a home TENS unit to minimise pain while you strengthen the muscles supporting your spine.
- TENS Machine
What are the Benefits of Good Posture?
- Keeps your bones and joints in the correct alignment.
- Helps to decrease the abnormal wearing of joint surfaces.
- Decreases the stress on the ligaments holding the joints of the spine together.
- Prevents the spine from becoming fixed in abnormal positions.
- Prevents muscle fatigue.
- Prevents any backache and muscular pain.
- Contributes to a competent and confident appearance.
To Achieve Good Posture You Will Require the Following:
- Good muscle flexibility
- Normal motion in the joints
- Strong postural muscles
- A balance of muscles on both sides of the spine
- Awareness of your posture, plus knowledge of proper postural position, which leads to conscious correction.
What is Good Posture?Standing with the good posture looks and feels fantastic, plus it's very healthy for your joints, muscles, bones, blood circulation and most importantly, your self-esteem. That's why proud and confident people stand tall with excellent posture. It's a habit! How you hold your body in space is your posture. Your posture is a direct result of the postural habits that you commonly exhibit. You can choose to hold good posture or poor posture. Gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture. The good news for you is that you can quite easily change your postural habits and train your body to sit, stand, walk, and even rest in great postures. Good posture also places the least strain upon your supporting muscles and ligaments. But, no one posture is good to maintain all day. As a human, you were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. This means that your best posture is your next posture!
Benefits of Good PostureGood posture:
- Prevents postural muscle fatigue.
- Correctly aligns your joints and bones to encourage efficient muscle activity.
- Helps minimalise joint stress.
- Avoids passive ligament overload.
- Prevents backache, neckache and muscular pain.
- Contributes to your enhanced confidence and a good appearance!
How to Improve Your Standing Posture:The number one tip to achieve a great standing posture is to simply"stand tall"! All the muscles that you need to push you taller are the same ones that improve your posture.
- Stand tall!
- Extend your head directly up (think balloon lifting your head with a string in the top of your scull) - but keep your chin tucked in. Avoid tilting your head forward, backward or sideways.
- Your earlobes will line up with the middle of your shoulders.
- Keep your shoulders back, your knees straight and your back straight.
- Let arms hang naturally down the sides of the body
- Lightly draw in your core stomach muscles. Avoid tilting your pelvis forward.
- Avoid locking the knees
- Ensure your feet arches are in a neutral (not flat) position.
- Stand with weight over the the centre of your feet.
- Stand with your feet slightly apart (shoulder-width).
- When standing for a sustained periods, shift your weight from one foot to the other, or stand in walk stand and rock your weight from your front to back foot.
How to Quickly Check Your Standing PostureStand against a wall with shoulders and bottom touching wall. The rear of your head should lightly touch the wall.
How to Correct Your Posture?If you experience discomfort in the above test and you can't easily correct your posture, you may have some restriction of joint, ligament or muscular movement. All of these problems can be quickly assessed and quickly improved by your physiotherapist. Please consult them for advice. Having difficulty maintaining a normal upright posture? You are probably suffering from reduced muscle endurance or strength. But these can both be easily improved with some practice of the right exercises. Your physiotherapist is an expert in prescribing the best postural exercises for you in a stage-appropriate manner to help your improve your posture without causing unnecessary pain or injury. You physiotherapist may also advise a posture brace or prescribe some posture taping to assist you to quickly achieve and maintain a good posture. Contact your physiotherapist for posture advice specific to you and your needs.
What is the Best Standing Posture?Standing with your best posture not only looks and feels fantastic, but it's also very healthy for you. Great posture is the best thing for your muscles, joints, bones, blood circulation and most importantly, your self-esteem. That's why proud and confident people stand tall with excellent posture. It's a successful habit! Good posture also places the least strain upon your supporting muscles and ligaments. How you hold your body in space is your posture. Your everyday posture is a direct result of the everyday postural habits. You can choose to hold good posture or poor posture. The constant compressive weight of gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture. It's actually quite easy to improve your postural habits. But it is a habit and researchers suggest that it takes 10000 attempts to create a habit. That's a good or a bad habit! Why not start the new you with a proud and posture perfect body today?
What is Your Best Posture?Humans were always designed to move and be versatile. You were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. When we were hunters and gatherers it was easy. But, with specialised jobs and postures, we tend to become static for too long these days and that causes postural fatigue, which leads to posture failure. This means that your best posture is your next posture!
Benefits of Good PostureGood posture:
- Prevents postural muscle fatigue.
- Correctly aligns your joints and bones to encourage efficient muscle activity.
- Help minimalise joint stress.
- Avoids passive ligament overload.
- Prevents a backache, neckache and muscular pain.
- Contributes to your enhanced self-esteem!
How to Improve Your Standing Posture:If I had to tell you one "switch" tip, it is simply to "stand tall" whenever you think about it. The muscles that you use to stand taller are exactly the same muscles that improve your posture.
- Stand tall!
- Think tall neck (ballerina or model style)- but keep your chin tucked in. Avoid tilting your head forward, backward or sideways.
- Your earlobes will line up with the middle of your shoulders.
- Keep your shoulders back, your knees straight and your back straight.
- Let arms hang naturally down the sides of the body
- Lightly draw in your core stomach muscles. Avoid tilting your pelvis forward.
- Avoid locking the knees
- Ensure your feet arches are in a neutral (not flat) position.
- Stand with weight over the centre of your feet.
- Stand with your feet slightly apart (shoulder-width).
- Shift your weight from one foot to the other when standing for a sustained periods. Alternatively, stand in a walk-stand and rock your weight from your front to back foot.
How to Quickly Check Your Standing PostureStand against a wall with shoulders and bottom touching the wall. The back of your head should lightly touch the wall. If you can't do this without pain or strain, you may have some restriction of some spinal joints, ligament or some muscle tightness. All of these problems can be quickly assessed and quickly improved by your physiotherapist with some joint mobilisations, stretches, massage and/or strengthening exercises. Please consult your physiotherapist for specific advice regarding your posture.
Posture Fatigue?Having difficulty maintaining your normal upright posture? You are probably suffering from reduced muscle endurance or strength. Postural muscle fatigue can be improved quite easily with repetitive contraction and periodic posture breaks. This will help to strengthen and improve your postural muscle endurance. Your physiotherapist is a professional in prescribing the best postural exercises for you in a stage-appropriate manner. They may consider temporarily prescribing you with a posture brace or prescribe some posture taping to assist you to transition, achieve and maintain the best posture for you.
Article by John Miller
What is the Best Way to Sleep?
Your Best Sleeping Position?
Everybody has their favourite sleeping position. However, some are better for you than others. Try to sleep in a posture that helps you maintain the curve in your lower back. We recommend lying on your back with a pillow under your knees (if more comfortable) or on your side with your knees slightly bent.
It is preferable to not sleep on your side with your knees drawn up to your chest (the foetal position). However, having said that some back conditions will find this preferable. You should seek the advice of your physiotherapist if you are in doubt.
If you are suffering back pain, you could try lying over a lumbar roll or peanut cushion at night to make you more comfortable. A rolled sheet or towel tied around your waist may also be helpful. You may wish to avoid sleeping on your stomach, especially on a saggy mattress. This sag can cause back strain and can be uncomfortable for your neck.
What is Your Best Mattress?
Select a firm mattress or an ensemble that does not sag. If necessary, place a board under your bed's mattress. You can also set the mattress on the floor temporarily if needed. If you've always slept on a soft surface, it may be initially painful to change to a harder surface. Try to do what's most comfortable for you.
How to Rise from Bed
When standing up from the lying position, turn on your side, draw up both knees and swing your legs over the side of the bed. Sit up by pushing yourself up with your hands. Bend forward at your waist with your core muscles activated.
What is Your Best Pillow?
The human neck curves slightly forward (to sustain the weight of the head when upright), and it is crucial to maintain this curve when in a resting position. If the height of the pillow is too high or low when sleeping, your neck is bent abnormally out of alignment, causing muscle and joint strain. You can even wake with headaches.
Poor pillow support can also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep.
The best lying or sleeping position may vary, depending on your symptoms. No matter what posture you lie in, the pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position.
To give your body the proper rest it needs, and to ensure the health of your spine, physiotherapists recommend only two sleeping positions: Side sleeping and supine sleeping.
Sleeping on your side, with the spine straight. Sleeping on your back, maintaining the primary curvature of the cervical spine. Both of these positions prevent poor alignment of the neck and upper back. Proper alignment can help to reduce the number of neck aches, backaches, pinched nerves, shoulder and arm referred pain, insomnia, and mental fatigue from a lack of effective sleep.
Common Sources of Spinal Pain & Injury
- Neck Pain - Cervical Spine
- Upper Back Pain - Thoracic Spine
- Lower Back Pain - Lumbar Spine
- Sacroiliac Pain - SIJ
- Scheuermann’s Disease
- Spinal Stenosis
- Rib Stress Fracture