Low Back, Mid Back and Neck Pain
Back pain, whether relating to the lumbar (low back), thoracic (mid-back) or cervical (neck) is a term that covers a wide range of pain experience, from first onset of achy fatigue following prolonged sitting or standing, through sprain/strain events, disc bulges & herniation, trauma, degenerative arthritis and stenosis presentations; all with increasingly severe pain and disability. Just as variable are the choices our clients chose with respect to recovery plans and treatment choices; and how they fare.
All of these pain presentations, with the exception of trauma, start with occasional, then more frequent episodes of fatigue and achy pain, and are a sign that the soft tissues of your back are under strain. Both gravity and activities which pull our attention forward contribute to this. With increasing time on a seated or standing task, the soft tissues of your back lengthen. Within the muscles, neural sensors continually monitor and send positional information to your brain. A long slow stretch is accommodated by your brain, until overstretch threatens tissue injury and elicits a pain response. Gradual stretch and time on task also alters the default muscle/brain feedback system. Thanks to neuroplasticity, so useful in acquiring new skills, the new skill in the achy fatigue situation is poor alignment and posture; and it is detrimental to both health and function.
Restoring the normal brain/muscle feedback system is important in all back pain presentations, regardless of the severity of actual back injury or pain condition. With moderate to severe pain, pain management strategies take precedence but corrective exercise needs to be started as soon as possible. Our clients find that when they are able to focus on the corrective movements, the exercise itself can temporarily relieve pain. The ability to effect pain relief with exercise is a powerful motivator, which builds upon itself with repetition. This strategy is useful, even with advanced disease; for which the goal is more comfort with less medication.
Treatment at our Clinic
We recommend physiotherapy assessment as the first step in care. If our client is presenting with pain relating to initial back pain presentations, the only care needed may be the restoration of brain/muscle feedback and the enabling exercises. The special nature of a corrective exercise program for back pain conditions is described in this link. Neuroplasticity and your Exercise Program
In more advanced stages of the conditions which associate with back pain, pain relief is our first priority. The physiotherapy assessment and program oversight is still the recommended first step, but laser therapy for tissue healing, massage therapy and acupuncture have a greater role in the overall treatment plan. Laser therapy is particularly valuable for its ability to reduce or eliminate the requirement for opioids and NSAIDS; and in this way conforms with the most recent guidelines from the Centre for Disease Control (CDC).
It is very important to control stress and anxiety, and to strive for calm when performing exercise for back pain. Stress negatively affects muscle tone and the brain/muscle feedback system. Both massage therapy and/or acupuncture can help to relieve stress. As neither of these practitioners are present when you do your corrective exercises, an open relationship with your physiotherapist is still key to your success. Your physiotherapist can help you understand how you can modify your environment to better perform your exercises, correct poor alignment, modify exercises so that you can reproduce them, and etc. When it comes down to it, your ability to restore the brain/muscle feedback system and to strengthen your back with respect to normal alignment is the essence of successful back treatment…and only you, our client, can do the required exercise ... but, we are here to help!
Attached is a PDF detailing how to manage back pain in a wide variety of situations.