Spinal pain is one of the most common problems seen by physiotherapists. In most cases, physiotherapy can help, but as in all problems, early assessment and treatment is vital.

Prognosis

The longer you have the problem, the more recurrent it is, the further down your arm or leg the pain travels and the more severe your symptoms, the worse your prognosis. If you have signs of nerve involvement (weakness in the arm/leg, numbness/ pins and needles in your hands or feet) this may indicate a longer recovery or a worse outcome.

Diagnosis

In about 80% of spinal pain the exact diagnosis is not apparent. This means that no-one can tell exactly what structure is injured. Physiotherapists usually use a biomechanical diagnosis. This identifies areas of the spine and surrounding structures, that have dysfunctional movement. Treatment is aimed at restoring pain free movement and function in the spine.

Treatment

Physiotherapy management in most cases seems to be beneficial in helping overcome spinal pain. Using a biomechanical model, modalities such as joint mobilisation/ manipulation, exercises, soft tissue therapy, traction and patient education can lead to a good outcome. Self treatment strategies are very important.

A combination of physiotherapy plus medical treatment may also be needed in more difficult cases. Though knowledge about back problems is not a core part of medical training, your doctor has access to advanced diagnostic options such as blood tests and advanced radiology (such as CT and MRI scans). If there are no serious underlying medical problems (such as infection or cancer), the basic medical tools would be medication, injection or surgery

Back Pain

Back pain is a common problem and if you suffer from low back pain, you are not alone. Managing your low back pain may not be a simple matter. You need to be aware of a number of factors to help you decide what to do to treat the problem and how you can influence outcome. Here are some things you might like to consider:

1. It may not get better on its own – In most instances of lower back pain, the problem may settle within a few weeks. However, many people are still affected in some way by their pain 12 months down the track. Also, flare-ups are very common. So, whilst you may get better doing nothing about your back pain, to ensure the quickest and best outcome you should seek assistance.

2. Physiotherapy can help – Physiotherapy can help you overcome an episode of low back pain. The goal of physiotherapy is to restore pain free movement, and to help you maintain this improvement over the longer term. Physiotherapists use a range of modalities to achieve these goals. These can encompass things such as hands-on type treatments, exercise therapy, dry needling or electrical modalities to name a few.

3. There may not be an overnight cure – Recovery can take time and can be related to various factors. These include the severity of the problem and also the state of your tissue prior to injury. For example, if you are a 55 year old manual worker, your spinal tissue may be degenerated (worn out) prior to injury. This may mean a slower recovery than in a 21 year old with less degenerative changes in the spine. Other contributing factors can include your general health, your weight, whether you are a smoker, your fitness and if you suffer from depression.

4. Anti-inflammatory medication – You should be wary of over reliance on anti-inflammatory medication. Whilst it may play a role in some cases, it should not be the only intervention you use to you treat your low back pain. Other modalities such as tailored exercises should be incorporated into the management program. Remember, a study in the USA a few years ago suggested that for every $1 spent on anti-inflammatory medication, a further 75 cents had to be spent treating the adverse side effects.

5. Core stability – ‘Core stability’ is a buzz word in low back pain management. Improving your ‘core’ muscles may help you overcome resistant back problems and avoid recurrence. These exercises need to be specifically tailored to your needs, usually by a physiotherapist with skills in this area.

6. Ongoing exercises – One of the biggest risk factors in suffering a back injury is a previous back problem. As such, you need to continue general fitness, mobilising and ‘core’ exercises long after you recover from your back injury to try to help prevent recurrent problems.

7. Posture and work – Your posture and the work you do can contribute to the development of low back problems. Prolonged sitting, working in a bent forward position and heavy or repeated lifting can all be factors in you developing a back problem. These need to be addressed if you want a good outcome.

8. X-rays –  There is very little value in having X-rays early on to help manage lower back pain. They have no value predicting who will get back problems, who has back problems or identifying what the problem is. Having too many X-rays throughout your life can be harmful to your health.

Neck pain

Neck pain is a very common complaint. Whilst physiotherapy treatment can help neck pain, it is very important that you learn to help control and manage the problem yourself. Here are some things to consider:

1. Poor posture – Poor posture can cause and aggravate neck pain. Learn how to maintain good posture during common activities such as reading, watching TV, sleeping and working. This will reduce neck strain.

2. Overuse – Overuse can over-stress the neck structures. Performing the same activity repetitively is unwise. Try to break up and vary your activity from time to time. Examples when overuse can be a problem include painting, gardening, practising your sport (e.g. tennis, golf), lifting, lifting weights and work activities.

3. Poor muscle control –  Poor muscle control may lead to fatigue and sub-optimal neck function. Strengthening your neck muscles can help you control your neck problem.

4. Treatment – Treatment can often help. Arrange to have treatment on your neck when problems arise or if your neck begins to deteriorate. Don’t leave it until problems become severe.

5. Heat and massage – Heat and massage are useful self treatment techniques. Heat often helps muscle spasm or tension. Rubbing creams with salicylate (aspirin) in them can give good localised relief.

6. Regular breaks are important – Regular breaks are important. Try to divide your activities into small chunks and have breaks in between. Performing gentle stretches and range of movement exercises (as prescribed by your physiotherapist) can be very useful during these breaks. Also, get up and walk around regularly.

7. Your chair is very important – Your chair is very important. Make sure you have a good chair for work, study or when at the computer. Your chair should have a good lumbar support, height adjustment and adjustable arm rests.

8. Computer height is important – Computer height is important. It should be at eye level and not too far away. You shouldn’t have to twist your neck to use your computer. You should have a document holder, good light and the keyboard should be at elbow level. Your physiotherapist can provide specific guidelines about setting up your work station properly.

9. Avoid tension whilst working – Avoid tension whilst working. When you are tense or you are over using the wrong muscles, it will put increased stress on your neck. An example of this tension is when you shrug your shoulders and hold this position. You will feel the tension in your neck. When you relax from this ‘shrugged ‘ position and let your shoulders drop down and relax, this reduces this tension. Learn to relax these ‘shoulder-neck’ muscles.

10. Improve your neck flexibility – Improve your neck flexibility. Reduce neck stiffness by stretching tight neck muscles and joints. A stiff neck is less able to withstand strain and loading. Have your physiotherapist show you what exercises you should do.