Spinal Stenosis

Spinal Stenosis

Article by John Miller

back-pain

What is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal canal and foramen, which results in “choking” of the spinal cord and/or nerve roots.

Stenosis usually involves the narrowing of:

  1. The spinal canal in the centre of the column of bones (spinal column) through which your spinal cord and nerve roots pass.
  2. The spinal foramen openings between your spinal vertebrae through which peripheral nerves leave the spine and go to other parts of the body.

What Causes a Spinal Stenosis?

Spinal stenosis most often results from a gradual, degenerative ageing process of your spine. As you age, the ligaments of your spine may thicken and calcify and start to compromise the adjacent tunnels. Your bones and joints also tend to enlarge due to increased bone stress and cause bone spurs, encroach on the spine’s space. Your spinal discs, between the vertebrae, become dehydrated with age and lose their height. This disc narrowing can deteriorate quicker with injury, e.g. disc bulges or degenerative disc disease.

Osteoarthritis of your spine (spondylosis) is the most common form of spinal arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process. It results from everyday wear and tear of the spine joints and is often accompanied by overgrowth of bone, the formation of bone spurs, which can cause spinal stenosis.

Spinal stenosis is most common in men and women over 50 years of age and is related to degenerative changes in the spine. However, it may occur in younger people born with a narrowing of the spinal canal or who suffer an injury to the spine.

What are the Symptoms of Spinal Stenosis?

Most commonly, spinal stenosis sufferers experience numbness, muscle weakness, diminished reflexes cramping or general pain in the arms or legs. The exact symptoms depend upon which part of your spine is stenotic and how advanced is your stenosis.

The most common stenosis regions of your spine are your lumbar spine (low back) and your cervical spine (neck), but any spinal region can suffer stenosis.

In lumbar spinal stenosis, the spinal nerve roots in the lower back are compressed. This can produce pain, tingling, weakness or numbness that radiates from the low back and into the buttocks and legs, especially with activity.

Cervical stenosis may cause similar symptoms affecting your arms and potentially your legs too!

If the narrowed space within the spine is pushing on a nerve root, you may feel pain radiating down the nerve, e.g. sciatica. However, unlike patients with sciatica due to slipped disc, this sciatica is relieved by sitting down in stenotic patients.

Classically, in stenosis patients, sitting or bending forward to flex the spine should relieve your symptoms. The flexed position “opens up” the spinal column and therefore enlarges the spaces between the vertebrae. Patients will often walk with a slight stoop forward or look downwards because keeping the lower back ‘flexed’ (bent forward) relieves their symptoms.

With this adaptive posture, the lower back is often stiff, and tightness develops in the hip flexor muscles at the front of the hips. Standing, walking or bending backwards often makes stenosis-related symptoms worse because this position causes narrowing of the nerves’ space.

Walking up a hill may be fine because leaning forwards opens up space around the nerves.

The space in the spine may narrow without actually producing any symptoms of stenosis. Only when the narrowing causes the compression of the spinal cord, nerves and nerve roots there may be an onset of stenosis symptoms.

Your neck or back may not even be painful. In severe spinal stenosis, you may experience constant or worsening back pain, numbness or pins and needles in the genital region, weakness in both legs, and or disturbances in bladder or bowel function. If this is the case, you require urgent medical attention!

How is Spinal Stenosis Diagnosed?

Your physiotherapist or doctor may diagnose you with spinal stenosis based on your symptom behaviour alone. However, the extent of your stenosis is best determined via a CT scan, MRI or myelography.

MRI Spinal Stenosis

Spinal Stenosis Treatment

PHASE I – Pain Relief & Protection

Managing your pain is usually the main reason that you seek treatment for stenosis. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.

Managing your inflammation. Inflammation is the main short-term reason for why you have suddenly developed stenosis symptoms. It best reduced via ice therapy and techniques or exercises that de-load the inflammed structures.

Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage and temporary use of a back brace.

Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.

PHASE II – Restoring Normal ROM, Strength

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. A normal order of deep, then intermediate and finally superficial muscle firing patterns is normally required for pain-free backs. 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 safely allow you to return to your desired activities.

Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some, it is simply 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 have a tendency to return. The main reason it is thought to recur 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 exercises 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 an important component to successfully preventing a recurrence. Your physiotherapist may recommend pilates, yoga, swimming, walking, hydrotherapy or a gym program to assist you in the long-term.

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.

What is Your Prognosis for Spinal Stenosis?

The success of treatment for stenosis is very good. A well-respected scientific study reported a 95% improvement in stenotic symptoms at 12 months. Surgery did provide with the quickest relief with a small risk of complications eg infection. A physiotherapist guided exercise protocol provided similar outcomes to surgery within a few months. But, both groups had a similar patient perceived improvement at 12 months. If you are interested in the spinal stenosis exercise protocol, please consult your PhysioWorks physiotherapist to see if you are a suitable candidate.

Other Treatment Options

Epidural Injections

If your stenosis symptoms persist, you could consider an epidural corticosteroid injection. While these injections can seldom be considered curative, they can alleviate the pain in about 50% of cases in the short-term.There are a number of complications and risks and therefore options should be discussed with your doctor.

Epidural injections appear to work most effectively when undertaken in conjunction with an active rehabilitation exercise program designed by your physiotherapist.

Spinal Stenosis Surgery

Surgery may be considered in patients where conservative treatment has been unable to prevent worsening symptoms. Surgery is usually only considered when the patient has severe constant pain that is making everyday tasks impossible and they have failed conservative exercise-based physiotherapy.

Surgery is more effective in those people who have leg pain from spinal stenosis. The results of surgery can be mixed and there tends to be a poorer outcome in patients who have diabetes, hip pain or pain that is predominantly in the back. Surgery will also be considered immediately if you experience numbness or pins and needles in the genital region; weakness in both legs; and or disturbances in bladder or bowel function. You will be referred to a spinal surgeon for their expert opinion.

The type of surgical intervention will be based on your specific pathology. The most common surgical procedure is a laminectomy, where a section of your vertebrae is removed to open the stenotic bone tunnel.

FAQs about Spinal Stenosis

Youth Spinal Pain

Teenager Neck & Back Pain

teenager back pain Teenagers 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)

Pelvis

For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor. Common Youth & Teenager Sports Injuries Common Youth Leg Injuries Common Youth Arm Injuries

Article by John Miller

Nerve Pain

Nerve pain is pain 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 typical type of pain that is due to an injury. It is known as nociceptive pain.

What Causes Nerve Pain?

nerve pain A problem with your nerves themselves, which sends pain messages to the brain, causes neuropathic pain.

What Are 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. Familiar sources of nerve pain include:
  • Shingles (post-herpetic neuralgia).
  • Trigeminal neuralgia.
  • Diabetic neuropathy.
  • Phantom limb pain (post-amputation).
  • Cancer.
  • Multiple sclerosis.
  • Chemotherapy.
  • HIV infection.
  • Alcoholism.
  • Other nerve disorders.

Nerve Pain & Nociceptive Pain

You can suffer both nerve pain and nociceptive pain simultaneously. The same condition can cause both pain types.

Nerve Pain Treatment

Nerve pain is less likely than nociceptive pain to be helped by traditional painkillers. Paracetamol and anti-inflammatories seem less effective.  However, other types of medicines often work well to ease the pain. Nerve pain is often relieved by anti-depressant or anti-epileptic medication. Please ask your doctor for more advice.

Pain Links

Pain & Injury

Tens Machine

What is a TENS Machine?

Article by John Miller

What Causes Pins & Needles?

What is Paraesthesia?

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" are "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 signify 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.

More info

Back Muscle Strains

Back 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 Sprains

Ligaments 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 Discs

A 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 Injuries

You 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 Posture

Poor 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 Pain

Although most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
  • Abdominal aortic aneurysm
  • Infection of the spine (osteomyelitis, discitis)
  • Kidney infection or kidney stones
  • Spondyloarthropathies: e.g. rheumatoid arthritis, psoriatic arthritis.
  • Female reproductive organs: e.g. pregnancy complications, ovarian cysts or cancer, endometriosis
Please seek the professional advice of your trusted and experienced healthcare practitioner to diagnose the cause of your lower 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%) 3. Non-Specific Lower Back Pain (NSLBP) (Bardin et al., 2017)

Specific Spinal Pathologies

Some conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include: These conditions do require early diagnosis and prompt referral to the appropriate medical specialist.  Luckily these conditions account for less than 1% of back pain sufferers, but you don't want them missed. Some referrals should be IMMEDIATE!

Radicular Syndromes

Lower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of back pain presentations 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: Pain is due to swelling or space-occupying material adjacent to the spinal nerve. The affected nerve may be irritated, resulting in radicular pain. Or, even worse, become pinched or compressed, resulting in radiculopathy.

Radiculopathy

Lumbar 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 Stenosis

Spinal 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 lower back pain sufferers 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 Causes

The 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 and 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 are the easiest way to recover quickly from lower back pain and 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 Strains

Muscle 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 Posture

Poor 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 Sprains

Ligaments 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.
You will usually feel better when resting and may find a change of position painful, e.g. sit to stand, rolling in bed, walking or bending.

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 Causes

We 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
More information about Back Pain More information about Deep Core Stability

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, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities 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

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

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, to name a few.

Physiotherapy Taping

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 acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

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.

Biomechanical Analysis

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.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

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.

Electrotherapy

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 problem, please contact your PhysioWorks team.

Article by John Miller

What is Therapeutic Ultrasound?

Therapeutic ultrasound is an electrotherapy modality that 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. ultrasound 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 Uses

Mastitis 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 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!
Like all medical equipment, when used by highly trained professionals, such as your physiotherapist, therapeutic ultrasound is very unlikely to cause any adverse effects. Please consult your physiotherapist for their opinion on whether therapeutic ultrasound could assist your injury. Therapeutic Ultrasound differs from Real-Time Ultrasound Treatment.

Ultrasound Physiotherapy Could Help You Beat Back Pain

Researchers have found that ultrasound physiotherapy has a 70% success rate of preventing a return of lower back pain within 12 months. The same study showed that those patients who didn't undergo the ultrasound physiotherapy had only a 16% chance of remaining pain-free. This finding means your chance of avoiding repeat back pain is 4.4 times better with ultrasound physiotherapy! Plus, there's even more good news. Researchers have discovered that 65% of sufferers didn't have another bout of pain within three years after undertaking ultrasound physiotherapy. This low recurrence rate means the ultrasound physiotherapy intervention also endures the test of time.

Brisbane Real-Time Ultrasound Physiotherapy Clinics

At PhysioWorks, we believe that cutting edge technology and treatment techniques deliver the best results for you. We welcome clients who are currently attending other spinal health practitioners without ultrasound-guided rehabilitation. We are happy to work with you and your spinal health practitioner to solve your back pain as quickly and effectively as possible. PhysioWorks has several real-time ultrasound physiotherapy clinics in Brisbane. The diagnostic ultrasound equipment is expensive, so only a handful of physiotherapy clinics offer this premium service. Allow up to 45-60 minutes for your initial scan, including assessment, corrective exercises and treatment. Please contact one of the following PhysioWorks clinics that provide Real-Time Ultrasound Physiotherapy programs to make your booking.

Book Online 24/7:

Ashgrove Ph 3366 4221     Clayfield Ph 3862 4544     Sandgate Ph 3269 1122

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 & Protection

Managing 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 Function

Depending 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 Recurrence

Recurrence 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.
A thorough assessment will determine whether you have radiculopathy or stenosis. This diagnosis is essential since treatment usually differs from NSLBP or radicular pain. For specific recommendations, please consult a musculoskeletal physiotherapist or another spinal healthcare practitioner. You probably already know that back pain has a nasty habit of returning within a few months of the initial injury. Research has shown that you have an 80% chance of recurring back pain within 12 months of the first episode.  The good news is that you can reduce your chances significantly if you do the right thing early.

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
Think about it. Back Pain is Something You Could be Suffering Needlessly. Please use our expert advice to guide you out of pain quicker and for a lot longer. If you have any questions regarding your back pain (or any other condition), please call us now to discuss your situation. You'll find our friendly staff happy to point you in the right direction.

Core Exercises

While 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 Transversus Abdominis (TA) muscle's regular activity. 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 PhysioWorks physiotherapist.

Article by John Miller

Core Stability Muscles

The deep core stability muscles of the lower spine include:
  • Transversus Abdominis (TA)
  • Multifidus (MF)
  • Pelvic Floor (PF)

Transversus Abdominis

core-stability-muscles The 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.

Multifidus

Multifidus (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 & Diaphragm

The TA and the MF work together with your pelvic floor and diaphragm to make a flexible but stable region around your lumbar spine. This ability to stabilise your lumbar spine in its many positions enables you to overcome back problems and reduce your reoccurrence chances. More info: Real-time Ultrasound Retraining