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Do I have a serious back problem?

Fortunately, most low back pain episodes fall under the category of non specific low back pain. As our previously blog post discussed there is a very good chance that you’ll experience back pain at some point in your life.

Some conditions can produce back pain that are more urgent to medically assess and treat. While statistically they don’t occur frequently, they fall into one of these categories:

 

Spinal Cord compression

In most people the spinal cord ends just above your low back. A group of peripheral nerves continue down through the rest of your spine known as the cauda equina for their resemblance to a horse’s tail. If either the spinal cord or the cauda equina are being compromised your symptoms will include:

  • Loss of sensation in your “saddle” the area that you wipe after going to the bathroom
  • A new change in your ability to hold in your feces or urine. Specifically, the inability to properly empty your bladder or a bowel and bladder that spontaneous empties when full without you being able to control it
  • Loss of sensation of both legs
  • Inability to control the muscles of your legs

 

Infections

Spinal infections are another potential serious source of low back pain. These symptoms will generally be associated with a fever and a history of infection. They are more common if you are immune compromised or use intravenous medication.

 

Cancer

Cancer of the spine can cause pain. The cancer can cause destruction of bone leading to bone pain. Cancer causing back pain can be ruled out if you’ve had no past medical history of cancer.  If you have had a history of cancer, are experiencing a new episode of low back, are experiencing a significant amount of unintended weight loss and pain that wakes you up at night, your doctor will refer you for an MRI to rule this out as a source of back pain. 

 

Fracture

If you are a healthy adult a spinal fracture requires significant traumatic force.  This can occur with a fall from a significant height or a motor vehicle accident.  If you have osteoporosis then large amount of forces are not required to fracture your spine.  In either of these cases your doctor will order an X-ray to rule out a fracture.

 

I don’t have those

Middle arrow of facet joint pointing to fracture of pars interarticularisThat’s a good thing! Just because you don’t have the above, or if they’ve been ruled out, it doesn’t minimize the back symptoms you have. The first step is to give back pain some time to improve. Try and keep moving as much as you are able to pain free. 

Most episodes of back pain will have a direction if preference. Some structures, like the spinal facet joints, when aggravated, become more painful when standing and feel better with sitting. Exercises such as biking would become a good way to maintain your fitness while respecting your pain.

Other areas like the muscles of the back, discs and ligaments often prefer positions of standing. Exercise that maintain back extension would be the best start and could include walking or swimming. 

 

Shouldn’t I get an MRI to see what’s going on?

Numerous studies have shown that in early stages, MRIs become important to rule out the above emergencies and urgent problems. The amount of “problems” found on X-Rays and MRIs increase as we age, but that doesn’t mean that these discovered problems are the source of your symptoms.  MRIs also become necessary if the worst pain is leg pain and not improving with conservative management. At that point an MRI will determine if you are a candidate for back surgery to take pressure off of the affected nerves.

Studies show that early imaging increases the number of surgeries performed but in the long term shows no benefit over those in a conservative treatment program.

 

I don’t want surgery but the pain isn’t going away

Video appointments are easy and can help you now with your pain

If your pain is continuing for more than 2 weeks then conservative management becomes the next strategy. With social distancing, this will likely involve a video consultation. If you’ve ever used the internet then you have the tools for a video consultation.

Your physiotherapist will take a detailed history to determine what factors may need to be addressed including past injuries and limitations. Various movement tests, nerve tests and joint tests can be performed without hands on touch to determine the best way to reduce your pain and get you back to normal. You will be taught exercises to reduce the pain and improve your function. 

During social distancing these sessions may be done online. A tailored program to address your pain, core strength and areas contributing to your symptoms will be prescribed.

 

 

 

Family Physiotherapy, assessing and treating persistent injuries and pains for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

 

References

Chou R. et al. “Diagnosis and Treatment of Low Back Pain: A joint Clinical Guideline from the American College of Physicians and the Pain Society” Annals of Internal Medicine 2007; 147: 478-91

Health Care Guideline: Adult Acute and Subacute Low Back Pain Institute for Clinical Systems Improvement January 2012 (15th ed.)

Jacobs W. et al “Surgery vs conservative management of sciatica due to a lumbar herniated disc: a systematic review” European Spine Journal 2011; 20: 513-22

 

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Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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The Inner Core 

Deep to our superficial muscles are a group of muscles that are frequently referred to as the deep core or “inner unit”. This unit can be thought of as a can deep within us. It is made of the diaphragm at the top, the pelvic floor at the bottom, the transversus abdominus at the sides and front and the lumbar multifidus at the back. These muscles have been shown in some studies to have a feed forward activation. In other words they contract before the muscles that create our spinal movements and regardless of how we move when functioning normally. When they are not functioning properly, they may contract too late resulting in  low back pain with light tasks.

 

Is Inner Core Training Right For Me?

Several clues will let your health practitioner know if inner unit training is right for you. Your provider should be taking a detailed history including the location of your pain, its nature and what brings it on and improves it. A detailed physical examination should include active movements as well as range of motion of neighbouring regions. If you are able to contract the muscles, you may be cued to contract them during limited or painful movements. If you are unable to contract them, your physiotherapist may apply pressure to certain regions to mimic the action of these muscles. 

If active or passive cueing of your muscles improves your symptoms of stiffness or pain then inner unit training may be appropriate for you. The exercises are not painful to do and the emphasis is on low level activation and building up endurance of the muscles in neutral positions.

As you improve the exercises should be progressed to functional positions and movements with the goal of maintaining a neutral spine while performing other exercises. Poor progression of these exercises is one of the reasons that you may have experienced a recurrence of your symptoms or didn’t feel like you returned back to full function.

 

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Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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Your Core

If you’ve ever experienced low back pain and looked up any information on how to improve your situation you’ve likely come across the term core.

Core weakness can appear as pain with performing seemingly light tasks, difficulty with repetitive tasks or inability to master the complex patterns in sports.

Core muscles imbalances can leave you susceptible to injuries to the knees, shoulders, hips and back.

But what is the core and how can it be addressed?

 

The Muscles of your Core

As a starting point, think of your core as the muscles in the region of your trunk. 

This includes superficially your abdominal muscles at the front, your large back extensors

and your lateral quadratus lumborum muscles.

These muscles connect with your latissimus dorsi muscles of your shoulders and your hamstrings gluteals and adductors of your legs.

These muscles tend to work in pairs to assist with controlling movement and improving efficiency. Whether it’s walking, running or throwing a ball, imbalances in these muscles can lead to pain and poor enjoyment of your day to day activities.

Over the course of the next few blog posts, we’ll walk you through these units, which tasks they are involved with and techniques to address them. We’ll link to them below.

 

Your Inner core

 

Deep to our superficial muscles are a group of muscles that are frequently referred to as the deep core or “inner unit”. This unit can be thought of as a can deep within us. It is made of the diaphragm at the top, the pelvic floor at the bottom, the transversus abdominus at the sides and front and the lumbar multifidus… (click here to read more)

 

 

Your Outer Core

There’s more to the core than just the deep muscles of the spine. Our previous blog post discussed the inner unit muscles and the role they play on spinal stability. But is that all that you need?

Functionally, there are more muscles involved in controlling our movements and improving our sports enjoyment and day to day activities. These additional muscles involve local muscles of the trunk and those connecting the trunk to… (click here to read more)

 

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Family Physiotherapy, assessing and treating persistent injuries and pains for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

Bend your knees when you lift?

What are some of the ways that you can reduce the chance of injury when lifting? Is bending your knees always the best strategy? Check out our video post on a few helpful tips to avoid injuring yourself during the start of gardening season.

 

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

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Low back pain

Incidence of low back pain

Low back pain is a common complaint.  A recent study has shown that the incidence of low back pain in the population ranges from 38% to 70% of an adult population.

Anatomy of the low back

The low back typically refers to the joints and tissues of the lumbar spine. This area represents the bottom 5 spinal vertebra (bones) between the thoracic spine and the sacrum (triangular bone in the pelvis). The vertebra are connected by the intervertebral discs. The back side of the vertebra are connected by symmetrical joints on either side, which are known as the zygoapophyseal (z-joints or facet joints more commonly).   A good analogy is to think of a tricycle.  The front tire represents the bone and disc while the back tires represent the joints.

Between the bones of the spine there are situated many ligaments that guide and restrict movements.  Further control of movement occurs actively through the coordinated contraction of the trunk muscles, in some cases before movement has occurred.  These muscles include some of the muscles of the abdominals and the muscles of the back more commonly known as the paraspinal muscles.

Between the bones of the back there are also nerve roots that exit to supply the muscles and tissues of the low back, hips, legs and feet.

 

What is the source of low back pain

There can be numerous causes of low back pain.

Low back pain from muscle strains

One of the most common sources of low back pain is local pain from one of the many muscles of the low back or muscles that refer pain to the low back.  The pain may have been caused by one activity such as occurs when lifting a heavy object or may have occurred after doing a repetitive task such or playing a sport.  Muscle pain is generally felt when the muscles are either contracted or stretched.

Low back pain from Nerves

Neurogenic pain refers to a pain due to an injury to the nerve or nervous system of the low back.  The pain can often be described as electrical and may shoot or jump to a different area.  Significant compression of a nerve root can result in the loss of sensation to further away regions of the body including the leg or foot.  If the nerve root supplies the muscles of the leg then one of the symptoms may include a giving out of the muscles when stress is placed on the nerve.  The affected area can be further away from the source of pain is generally felt when pressure is put on the nerve with standing postures, twisting or in some cases with prolonged sitting or stretching.

Low back pain from the Facet Joint

Pain symptoms elicited from the joints of the spine is commonly known as facet pain.  The pain often is at the low back but can radiate to the back of the thighs as well.  Postures that create compression of the region can elicit symptoms, this can be as extreme as carrying heavy weight on the shoulders or as mild as standing upright for long periods of time.  This area is often negatively affected by restrictions of movement in the shoulders, hips and knees.  The common position of ease is typically sitting down or leaning on the arms.  There is often an associated muscle weakness of the hip which is often felt when getting out of a chair.

 

Low back pain from the Disc

The lumbar disc provides restraints to excessive amounts of bending and twisting.  In younger spines the disc has a high water content and is vulnerable to injuries that involve sustained bending of the spine with or without twisting.  Injures to discs are often described as herniations or protrusions.  If the injury is large enough there can be pressure placed on the exiting nerve root which can result in nerve pain radiating into the low back and different parts of the leg.  Symptoms usually worsen in bent forward positions which can include sustained sitting.  With irritation of disc pain pain often radiates, or peripheralizes, away from the injured structure.  Often people with disc pain need to stand up to make the pain reduce.  This is often felt as a reduction of peripheral symptoms making you more aware of pain at the injured disc.  This phenomenon is know as centralization of pain and needs to occur for the disc to heal.

 

Other causes of low back pain

  • Soft tissue strains due to poor posture and muscle imbalances
  • Spondylolysis and spondylolisthesis
  • Trauma to the tissues or joints
  • Bone pain from loss of bone density
  • Joint pain from abnormal loading of the joint
  • Organ pain referral to the low back such as occurs with kidney stones
  • Emotional or psychogenic pain

 

Risk factors for low back pain

Some episodes of low back can’t be avoided.  However there are some factors that can increase your likelihood of having an episode of low back pain.  In one study these were found to include:

  • limping during the first few steps
  • hip/knee pain during sitting
  • overall widespread pain were associated with the first incident low back pain
  • having had a prior low back pain
  • having another current other musculoskeletal complaints
  • Men and women with prior low back pain were more inclined to report incident low back pain
  • Individuals older than 70 years with strength that was more than 50% within the same population

What can be done about low back pain

Manual therapy for low back pain
Family physiotherapy serving Markham and Thornhill

 

 

 

 

 

If you are experiencing low back pain the first step is identifying how to reduce your pain.  In some cases you will instinctively move or adopt positions to reduce the pain, but if there are multiple causes of low back pain then the easing position is not always apparent.  Often professional advice by on the proper way to move or sustain a position of the spine will help to reduce the pain that you are experiencing.  This should be done by a physiotherapist with training in spinal pain and conditions.  Part of the assessment by your physiotherapist should include a detailed history including previous injuries and medical condition, changes in activity or office setup in the months preceding the pain.  Often a series of movements of the spine can be given to help to continue to reduce the pain that you are experiencing.  For most low back pain a comprehensive physiotherapy assessment will be able to determine the cause and appropriate treatment for pain.  In most cases X-Rays and MRIs are not required unless back pain symptoms have been resistant to appropriate conservative treatment including core retraining and a flexibility program.

As your symptoms reduce in intensity the next step becomes to identify areas of restricted mobility, strength or poor posture that may have led to the development of the pain in the first place.  These can include simple body weight or weighted exercises or may involve flexibility or ergonomic advice.  If your goal is to return to sport or higher level activities there should be a transition to more sport related exercises and flexibility programs.

 

Prehab for low back pain

Muscle imbalances, lost mobility and strength deficits are most easily addressed and at a much lower cost if you are not currently in pain.  The proactive approach is to check out your problem areas before your next flare-up hits.  Don’t limit your daily routines and activities because of past pain.  

 

Related Posts:

 

Not Sure Where to Start?

Our team of physiotherapists, massage therapists and naturopathic doctors have training and experience to help get you get your symptoms under control and to prevent recurrence.  Call or email us for more information!

 

 

Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan

 

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today