Low Back Pain Facts

If you have back pain, you are in good company, in fact according to The Australian Institute of Health and Welfare (1), about 4 million Australians have it every year!

Estimates say that 70-90% of all people will have back pain at some time of their life.

But don’t worry, most low back pain is acute, or short term, and lasts a few days to a few weeks.

Back pain usually will resolve on its own with self-care and there is no residual loss of function or “damage”.

Here are some key back pain facts for you:

  • Men and women are equally affected by low back pain.
  • It is the most common cause of job-related disability and a leading contributor to missed work days in Australia. (1)
  • The likely hood of back problems increases with age, with 55-74 being the most common age group. (2)
  • Exercise and physical activity are very important for the prevention and management of back problems. It’s important to remember that both too little and too much activity increases the risk of ongoing low back pain.
  • Moderate to strong risk factors for lower back pain include heavy manual workload and repetitive lifting, with stronger associations for flexed, rotated or awkward positions of the spine. (1)
  • Your body weight can increase your risk of having back problems. The more overweight you are, the higher the risk: obese (40%) compared with people without back problems (29%). People with back problems were less likely to be overweight, or underweight/in the normal range compared with people without back problems (1)
  • Persistent back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain may have resolved.
  • About 20 percent of people affected by acute low back pain develop persistent low back pain with persistent symptoms at the one-year mark still. (3)
  • Pregnancy is commonly accompanied by low back pain, which results from pelvic changes and alterations in weight loading. Back symptoms almost always resolve postpartum.

Top 6 low back pain questions answered by Matthew Ash, an experienced Spinal Physiotherapist.

low-back-pain-thumbnail-01

What has caused my back pain?

Sprains and strains of the muscles and tissues around the spine are the most common cause of low back pain. However, the truth is that we usually cannot pin point the exact structure or cause for low back pain. We do know the tissues in the lower back becomes inflamed, and the body responds with pain and muscle guarding as a protective response. This is normal, and is part of the response to look after the tissues and help them heal.

I didn’t actually do anything to cause it, so why does it hurt?

We are all designed with protective mechanisms to look after our body when there is danger to the tissues. If you hurt your back, it is normal to experience some pain and protective muscle guarding, which often changes our postures and how we move. In the first week or so after an injury, these protective responses are normal, however is some cases those protective postures and movement patterns can end up being a bit unhelpful, and can be a cause of pain even after the original injury has healed.

How long does it usually take to feel better?

Everyone is different, so recovery times are going to vary from person to person. At lot of minor low back sprains & strains will settle down over a few weeks; however, they can take up to 12 weeks to settle in some cases.

If it hurts to do things, then should I avoid them?

We know in most cases of back pain the spine itself is strong & sound, and does not need to be ‘protected’ further by avoiding movement and activity. It is widely accepted that complete rest is unhelpful when managing low back pain, whether that’s following an acute injury of with more persistent pain. In the first few days after an injury, it is better to reduce and modify your level of activity, however keep moving and stay as active as you feel comfortable. Normalising movement will in fact help to settle down pain. Think of this as ‘relative rest’. Yes, you should avoid any strenuous activities that specifically aggravate your pain, but it is ok to move, even if it feels a bit uncomfortable.

Once I have hurt my back once, then will I likely do it again?

The short answer here is no. The body is extremely good at repairing itself, and as mentioned above things will usually settle down over a few weeks. However sometimes when in pain you can become a bit deconditioned, so it may be helpful to do some movement and conditioning exercises to make sure you get back to the things you want to do.

Should I have a scan to check my back to make sure that I haven’t damaged my back badly?

A recent systematic review from 2016 in the American Journal of Neuroradiology has shown that it is normal to experience changes in the lower back with age, just like getting some wrinkles or grey hairs on the outside. So in most cases suggestions of ‘disc degeneration’ or ‘disc bulge’ that show up on MRI or CT scan are likely due to normal changes with age but don’t necessarily provide any helpful information about why you may be in pain. Any scan results need to be consider in context with the overall clinical picture.

Scans can be helpful to exclude more serious pathology involving compression of spinal nerves or the spinal cord, or instability due to fracture, but these cases make up a very small percentage of low back pain.

Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations W. Brinjikji et al American Journal of Neuroradiology April 2015, 36 (4) 811-816

By Matthew Ash
myPhysioSA Spinal Physiotherapist
Mount Barker & International Spine Centre Wakefield Hospital Adelaide

The myPhysioSA take on having back pain and getting older!

We all get some wrinkles and grey hairs; getting older is a normal part of life. Some would even say the ‘salt & pepper’ look is a bit trendy these days; at least I hope it is when I look in the mirror. Just like we see changes on the outside, we all get ‘wrinkles and grey hairs’ on the inside as well. The thing is, changes on the inside are usually referred to as degenerative, or ‘wear & tear’, which draws an association with something being abnormal, or something wrong. However, in reality, there are many cases where this degeneration is in fact normal.

So if aches and pains are a normal part of life, what is the answer to try and manage them?

Regular relaxed movement is a good place to start. Muscles and joints like to move. ‘If you don’t use it you lose it’ is a classic phrase that really does sum up what happens with your body. So if your body is designed to move, then movement can be the simplest answer to address some of those aches and pains. It may not take away every pain, but it can help to keep the joints oiled, muscles strong and your body healthy, and therefore make it easier for you to manage the things you want to do on a daily basis.

In fact, if you have experienced pain for a long time, latest research suggests that exercise through movement is more effective at reducing pain than taking medication. And it’s not all about types of exercise that makes you puff or sweat. You can often achieve a lot more with gentle and regular movement through the day. It can be as simple as standing up from a chair so you are not sitting for too long, or going for a leisurely walk. Maybe performing some gentle exercises or stretches each day.

Pacing activities around home is another good option, whereby you break up tasks into smaller chunks rather than trying to complete the activity all at once.

These strategies can all be helpful to try and reduce your aches and pains.

Learn About Your Spine

Your spine is built to move, bend, lift, carry, run and have fun with!

Your spine is robust and strong!

Listen to Josh, one of our Mount Barker Physiotherapist team, explain all things spine:

Josh explains in simple terms how your spine moves using a model of a spine.

Other key learning points about in this video include:

  • Your spine is robust and inherently strong
  • Pain does not mean damage or that anything is structurally wrong with the spine
  • Your low back is mostly designed to bend and arch Key structures are shown on the spine i.e. discs, muscles, facet joints, nerves

What structures make up the back?

The lower back where most back pain occurs includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain. (3)

So what about posture- can it cause back pain?

At myPhysioSA our spinal Physiotherapists tell people:

“Your best posture, is your next posture”

– There is no such thing as a bad posture. Just look at the way young children sit, how many awkward, asymmetrical positions can they put themselves into! The key though, is that they are constantly on the move from one position to the next.

That is the key, change up your positions regularly. It’s only when we stay in one position too long that tissue stress starts to happen on certain muscles, ligaments, nerves etc, which may cause tightness and stiffness to build up.

People who prolong sit are more prone to back pain than active trades people who lift and carry all day. Prolonged low load tissue stress can be build up over time and be a cause of stiffness and pain.

Information about safe lifting for your spine

https://www.safeworkaustralia.gov.au/manual-handling (4)

Lifting & Carrying Techniques

  1. Check or clear the area you will be carrying the object in.
  2. Check the load to make sure it is safe to handle.
  3. Size up the load to check weight and stability Place your feet in proper position, with front foot beside the object facing direction of travel and back foot behind the object. Feet should be approximately hip width apart.
  4. Bend your knees!!! This will ensure you are using your leg muscles and not your back muscles.
  5. Obtain a proper hold of the item, with hands diagonally opposite and using your whole hands and fingers.
  6. Make sure your back is straight as possible and as close to vertical as possible.
  7. Finally always use your leg muscles. While lifting and carrying the load you should not turn or twist your body. Putting the load down is simply a reverse of the lifting procedure.
  8. Always remember: never lift anything that is too big, heavy or awkward.

Poor Posture & Back Pain

Matt, a myPhysioSA Spinal Physiotherapist, gives the facts about posture and back pain.

The answer isn’t what you think.

The latest evidence tells us there is no definite link between someone’s poor posture position in standing or sitting that is linked to an increase chance of having back pain.

Our experience as Physio’s is that the body loves to move and often! Our key advice to our clients is to just keep moving and avoid sustained static positions.

Your next posture is your best posture

myPhysioSA Spine: Payneham & Mount Barker

Is your back or hip pain due to muscle pain?

The answer is; yes it could be.

Pain in your upper or lower back or hip area can come from:

  1. muscles
  2. your spine or vertebrae including discs, joints and ligaments
  3. or even from your nerves

So how do you know where your pain is coming from?

It usually takes a detailed assessment from a health professional to diagnose the exact cause of people’s pain, even then there can be a fair bit of guess work involved! The human body is very complicated.

The good news is, you don’t necessarily always have to know exactly where the pain is coming from to actually make it better.

So do I have muscle pain in the back or hip?

Muscle pain often is explained as a dull-ache that can build when we are prolonged sitting, standing or doing repetitive bending, lifting, carrying movements.

If a muscle is unhappy, you may also get sharp pain or even intense painful spasms from muscles when moving.

Pain due to inflammation is usually constant, worse at rest and difficult to ease, and nerve pain has that burning feel to it, and often has tingling or an altered sensation as well. Pain from spine structures can also act like muscle pain, which is why exact diagnosis can be difficult.

What can I do if it seems to be muscle pain?

  1. Avoid the key sustained positions or movements that seem to aggravate it.
  2. Keep being active and keep moving.
  3. Use heat ie wheat bags, heat cream, hot shower etc.
  4. Do regular muscle stretches and use a foam roller or a massage ball to release muscle tension.
  5. If nothing seems to be helping, then seek help. myPhysioSA Physiotherapists are here to help diagnose your back or hip pain. They will explain to you in plain English what the problem is, and what the best plan is to help you get back on track fast.

By David Wilson
Partner Physiotherapist myPhysioSA Mount Barker in the Adelaide Hills

Where is my low back pain coming from?

Get professional back pain advice from our Partner Physiotherapist Josh Stewart from myPhysioSA, Adelaide, Australia.

Josh explains in simple terms about where your back pain may be coming from.

Other key learning points in this video include:

  • The truth about scan results
  • Pain is only an alarm system
  • The importance of getting moving again

Acute Low Back Pain

What is acute LBP?

Most people will have at least a few episodes of acute low back pain through there lifetime.

Sometimes acute episodes start for no reason, you can even just wake one morning with back pain.

But don’t be alarmed, because acute back pain will usually settle quickly. For the vast majority of people, it will only last for 2-6 weeks. Only a small percentage of people will develop persistent low back pain.

The first few days can be painful and you will feel like limiting your activities and avoiding the painful movements.

Often there is no one low back structure that can be blamed for your pain, us Physio’s call it ‘nonspecific low back pain’.

‘Read our best Physio advice below on how you should manage your acute low back pain’

What to do when you experience acute LBP?

Pain can stop you in your tracks.

It is normal to have pain at times.

Matthew, a Spinal Physiotherapist in Adelaide, explains why we have pain and also why it can sometimes be persistent.

The best advice that Matthew can give is to return back to normal moving as soon as possible.

Matthew Ash consults at myPhysioSA Mount Barker, The International Spine Centre and The Hills Integrated Pain Team.

Should I just take some pain killers and push through my back pain? Or is it causing damage?

Back pain can be responsible for significant activity limitation in an individual. The Australian Government Institute of Health and Welfare, reports that 1 in 7 Australians (14%) had an incidence of low back pain in 2011-12 and it is estimated that up to 90% of Australians will experience an episode of low back pain at some stage in their life.

The cause of back pain is varied.

It can be associated with postural or structural injury, and can be related to bones, joints, muscles, nerves and connective tissue.

However, the majority of back pain, around 80%, is non-specific, meaning it can be difficult to pinpoint the exact structure that could be the culprit.

It is for this reason that it is important to have an understanding of what could be causing the pain before considering the right treatment approach.

One of the most important strategies to manage back pain is to keep active and moving. This is what the back is designed to do. It can be argued that analgesic medications can assist in keeping you moving and active, and in some cases, early pain management could also reduce the risk of developing chronic pain.

However, you can also argue that the world we live in today is heavily reliant on medication to manage pain, and to question whether this is in fact the right option.

Recent research, as reported on ABC radio, suggests opioid medication could possibly make nerve based pain worse, and could therefore contribute to more persistent or chronic pain.

There has been a boom in pain research over the last decade in which we are learning more and more about how pain actually works.

But what does that actually mean?

It means that all pain is NORMAL! It is a vital protective response within our nervous system, designed to tell us if there is danger.

Which brings us to the crux of the question; should I take pain killers and push through pain, or is it causing damage?

In some cases, like with an acute injury, pain may in fact indicate danger or damage to the body. The human body is a fantastic healer, however in this case, taking medication to push through pain could cause further tissue damage, and therefore would not be the right choice.

On the contrary, sometimes a pain response is merely protecting us against potential danger, without actual damage being present.

Physiotherapists know that the best management for back pain is a combination of treatment options, including hands on therapy, exercise, education, and in some cases medication. The use of medications should be tailored for the individual.

They should vary depending on the type of injury, the degree of physical limitation, the medical history of the patient, and based on the time frames of tissue healing.

So the best course of action before taking any medication for back pain would be to seek advice from your health care professional beforehand.

At least then you will be able to make a more informed decision about the best course of action.

If you are suffering from low back pain, book a consultation with your physiotherapist today.

Matthew Ash, myPhysioSA Senior Physiotherapist myPhysioSA Mount Barker and myPhysioSA Spine

How to get you’re back moving again with acute low back pain

Get professional back pain advice from our Partner Physiotherapist Josh Stewart from myPhysioSA, Adelaide, Australia.

Josh explains in simple terms about why it’s important to get moving again to help your low back pain.

Other key learning points in this video include:

  • The latest research tells us that it is important to get moving early and keep moving if you have low back pain
  • Start with safe gentle movements “non-sweaty movement”
  • How to start pacing activities
  • The truth about posture and back pain

Josh is a Partner Physiotherapist at myPhysioSA Mount Barker

Persistent Low Back Pain

What is persistent low back pain?

Persistent or chronic low back pain in the past has been classified as low back pain that has lasted for 12 weeks or longer.

Do you have persistent pain that won’t go away? Back, neck, shoulder, arm or leg pain

If your doctor or specialist has diagnosed you with persistent or chronic pain but say they aren’t able to help you anymore besides giving you stronger medication that doesn’t really help, then you should watch this video.

Matthew, one of our Physiotherapists from the Hills Integrated Pain Team, explains how and why persistent pain can develop, using a “bee hive” analogy to explain how the nervous system becomes sensitized about the area of pain.

Learning more about persistent pain is the key to learning how to not only manage it but start to get on with your life again.

Matthew Ash, Senior my Physio SA Physiotherapist and Hills Integrated Pain Team member

What can you do to help persistent pain? Three strategies by Mathew Ash one of our Mount Barker Adelaide Spinal Physiotherapist

If you want to help persistent pain in your back, neck, hip, shoulder or knee pain then you should watch this advice.

Matthew, a Senior Physiotherapist and Hills Integrated Pain Team member, explains three strategies you can start doing right away that can really help.

Starting a form of physical activity, using a pain diary and learning about pacing strategies, are all covered by Matthew, and are proven techniques to start to manage your chronic condition and improve your quality of life.

Mathew Ash, Senior Physiotherapist and Hills Integrated Pain Team member

Below is some advice and Physio options that our Spinal Physio’s have for you:

How Physiotherapy Can Help Persistent Low Back Pain?

Persistent Low Back Pain & the influence of Poor Movement Patterns.

Persistent low back pain (i.e pain that has been present for 3 months or more which would otherwise have been expected to settle down) is one of the major causes of disability in society.

This type of low back pain can have many contributing factors which can include the following to name a few:

  • Muscle strength/weakness issues
  • Flat feet (over pronation)
  • Obesity
  • Poor posture
  • Poor ergonomics i.e. work station set up
  • Poor movement patterns

Understandably, a comprehensive myPhysioSA assessment is crucial to identifying the underlying causes of the problem/pain rather than just addressing the symptoms alone with ‘band-aid’ approach.

In doing so, we are well placed to formulate a plan in conjunction with our patients, to address each causative factor thus maximising recovery – which is what it’s all about! Something I observe regularly throughout my daily clinical work is the influence of ‘poor movement patterns’ on the persistence of low back pain, as listed above.

This is something that can often be missed when dealing with this type of pain and yet has a profound effect on the recovery of patients experiencing this long standing type of low back pain.

To be more specific about low back pain.

I like to think of poor movement patterns as ways of moving throughout our day to day activities that cause unnecessary stress on our spine, thus aggravating pain.

For example, when we have an acute back injury, commonly by twisting awkwardly to pick something up, or reaching an object – our back can go into ‘spasm’. When in spasm, patients will often hold themselves straight to avoid the pain associated with moving when the back is in such an angry state. This can be a useful response in the first 48 hours to allow the injured area to settle down.

However, maintaining such rigid postures ongoing can cause unnecessary stress on the back, especially if we become inadvertently fearful of aggravating our back again. Adding fuel to the fire so to speak is the common understanding that we need to keep our back ‘straight’ and ‘sit up tall’ which I’m sure most of us have been told at one stage or another. This does have some merit, however there is such a thing as being too straight for too long, which can contribute to a cycle of ongoing back pain.

In a nutshell:

We need to ensure that our normal pre-injury movement patterns are restored to avoid further reaggravation courtesy of ongoing guarding of our back and fearful movement. Such patterns of movement become automatic such that we don’t even know we are doing it.

If I can indulge in an analogy….. it is a little like driving a manual car – once we have been doing it for a while, we no longer need to think about changing the gears. We do it automatically as it becomes second nature. Day to day movement is the same. However, with the right assessment, advice and practice, this can be changed!

This further highlights the importance of a thorough myPhysioSA assessment to comprehensively check for these issues and manage them accordingly, thus maximising recovery!

By Tim Bass
myPhysioSA Partner & Spinal Physiotherapist’s

Hills Integrated Pain Team – Persistent back & neck pain advice

Persistent or chronic back & neck pain is reality for many people. They stop doing activities they used to enjoy, struggle to work and to maintain relationships.

Chronic pain is complex and needs a multi-pronged approach.

The Hills Integrated Pain Team in Mount Barker, Adelaide Hills, helps people with persistent back, neck, leg or shoulder pain.

Our Spinal Physiotherapist’s work in conjunction with Pain Psychologist’s to road map you through to self-managing your problem.

Call 1300 189 289 to enquire or check out our Hills Integrated Pain Team page here for more information.

Do you have muscle, joint or spine pain that just keeps persisting? Our Pain Team can help.

Matthew, a member of our Hills Integrated Pain Team, discusses a recent client who had debilitating persistent back pain and how he was able to improve with the Teams guidance.

Back pain can end up ruling your life, by stopping you from doing what you enjoy, stopping you from being able to work, stopping you from going out and being social etc etc.

Hearing someone’s success story and knowing that there is help out there, and without the use of more medications, is what people with persistent pain need to know.

If you know someone with ongoing muscle, joint or spine pain that isn’t being helped by anything and they are just ‘living with it’, and their whole life is being affected then show them this video.

Matthew Ash, Senior Physiotherapist & Hills Integrated Pain Team Member Mount Barker, Adelaide Hills

LBP with leg symptoms

Why do we get leg pain coming from our back?

Leg pain (sciatica or referred pain are common names) can occur with low back pain.

Although commonly referred to as ‘sciatica’, the term lumbar radicular pain (LRP) is anatomically more correct.

The pain may track down into different areas of your thigh, lower leg and foot, either the front, back or side.

There are two broad types of back related leg pain:

Radicular referred leg pain: This is when a nerve is irritated or compressed as it’s coming out of your spinal cord and passing through the radicular canal between your vertebrae. The radicular canal is pictured below.

Radicular pain will be felt where that spinal nerve travels to and the area it supplies. Each lumbar spinal nerve supplies a different area of your leg, in what we call a dermatome distribution. See the image below:

Radiculopathy occurs when a compressed or inflamed nerve root results in neurological deficits, such as problems with reflexes, numbness, and/or weakness. Radicular pain and radiculopathy often occur together, but can be independent.

Radicular syndrome is often caused by direct pressure from a herniated disc or degenerative changes in the spine that cause irritation and inflammation of the nerve roots by bone spurs or collapse of the nerve root tunnels (foramen).

Sensory symptoms are more common than motor symptoms, and muscle weakness is usually a sign that the nerve compression is more severe. The quality and type of pain resulting from radicular syndrome can vary, from dull, aching and difficult to localize, to sharp and burning.

Causes of radicular pain

  • Disc herniation (commonest cause)
  • Spinal stenosis
  • Synovial cysts
  • Infection
  • Infestation
  • Tumour
  • Vascular abnormalities

Distinguishing features of LRP and somatic referred pain

FeatureRadicular painSomatic referred pain
DistributionEntire length of lower limb
BUT
below knee > above knee
Anywhere in lower limb
BUT
proximal > distal
PatternNarrow band
Wide area
TravellingRelatively fixed in location
Quasi segmental but not Quasi
Segmental but not dermatomal
Not distinguishable by segment
Boundaries difficult to define
QualityShooting, lancinating like an electric shock pressure
Dull, aching, like an expanding
DepthDeep as well as superficialDeep only, lacks any cutaneous quality

Somatic referred leg pain

  • Somatic referred pain is pain that is being referred into your leg from a structure in your back
  • Somatic structures include: muscles, discs, ligaments, bones etc. Anything musculoskeletal tissue that has a nerve supply is classed as a somatic structure.
  • Referred pain is pain perceived at a location other than the site of the painful stimulus/origin.
    • It is the result of a network of interconnecting sensory nerves, that supplies many different tissues.
    • When there is an injury at one site in the network it is possible that when the signal is interpreted in the brain signals are experienced in the surrounding nervous tissue.
    • Source: https://www.physio-pedia.com/Referred_Pain
  • A common low back example is an inflamed lumbar facet joint referring pain into your buttock and back of thigh area.

Do you need a scan or investigations for your LBP?

There are several reasons to avoid back scans if they are not completely necessary:

  • Most scans for low back pain find no abnormalities or only minor changes. Scans done on patients without back pain show similar degenerative (or ‘arthritic’) changes to those found in patients with back pain.
  • Having a scan of your back does not improve your pain or help you to recover.
  • Unnecessary x-rays and CT scans bring risks of radiation exposure.

Radiation from medical tests may cause damage to cells in your body. Large doses may cause the cells to become cancerous. The low dose of radiation exposure from an x-ray carries a tiny risk. CT scans, which use higher doses of x-rays, have a higher risk (although it is still very small). Your doctor should always balance the possible benefits of you having the test with the small risk.

Source: https://www.sahealth.sa.gov.au/wps/wcm/connect/1227450049e4e01cb4bffe3a89b74631/ScansAndLowBackPain-RAH-AlliedHealth-120123.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE1227450049e4e01cb4bffe3a89b74631-mMzvfdu

One of our Partner Physio’s Josh explains in simple terms about where your back pain may be coming from.

Other key learning points in this video include:

  • The truth about scan results
  • Pain is only an alarm system
  • The importance of getting moving again

Scans may be needed if you have:

  • a/ Red flags
  • b/ Deteriorating neurological signs
  • c/ Symptoms not improving over time despite good conservative management

A/ Do you have any Back Pain Red Flags that need to be ruled out?

  • Indicate possible serious pathology
  • Indicate the need for further investigation and, possibly, specialist referral
  1. Possible fracture
    • Major trauma
    • Minor trauma in elderly or osteoporotic patient
  2. Possible tumour/infection
    • Age < 20 or > 50 years
    • History of cancer
    • Constitutional symptoms (fever, chills, weight loss)
    • Recent bacterial infection
    • IV drug use
    • Immunosuppression
    • Pain worse at night or when supine
  3. Possible significant neurological deficit
    • Severe or progressive sensory alteration or weakness
    • Bladder or bowel dysfunction
    • On physical examination: evidence of neurological deficit (in legs or perineum in the case of low back pain)

B/ Worsening numbness, weakness and tingling or inability to normally use your bladder or bowel are classed as deteriorating neurological signs.

If any of the above worsen then medical advice is needed ASAP. Especially if you lose bladder or bowel function, it can be a medical emergency. Seek urgent medical care.

C/ Symptoms not improving over time despite good conservative management.

In general, if you have had symptoms persisting greater than 12 weeks despite help from your GP or Physio then it can be warranted to get an XR to help rule out any red flags or other structural issues.

Have a talk to your GP or Physio and discuss a plan for investigating your back pain further. Often these tests are all clear, which is great! It will mean that your back pain will just take a little more time to improve with the right guidance and advice from your medical team.

How is low back pain diagnosed?

This excellent fact sheet by Ninds covers the various types of scans that may be used:

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain.

During the exam, a health care provider will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain.

Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination.

Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including tumours and spinal stenosis. Imaging and other types of tests include:

  • X-ray is often the first imaging technique used to look for broken bones or an injured vertebra. X-rays show the bony structures and any vertebral misalignment or fractures. Soft tissues such as muscles, ligaments, or bulging discs are not visible on conventional x-rays.
  • Computerized tomography (CT) is used to see spinal structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumours. Using a computer, the CT scan creates a three-dimensional image from a series of two dimensional pictures.
  • Myelograms enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scans.
  • Discography may be used when other diagnostic procedures fail to identify the cause of pain. This procedure involves the injection of a contrast dye into a spinal disc thought to be causing low back pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection. Discography may provide useful information in cases where people are considering lumbar surgery or when their pain has not responded to conventional treatments.
  • Magnetic resonance imaging (MRI) uses a magnetic force instead of radiation to create a computer-generated image. Unlike x-ray, which shows only bony structures, MRI scans also produce images of soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumour, inflammation, disc herniation or rupture, or pressure on a nerve is suspected. MRI is a non-invasive way to identify a condition requiring prompt surgical treatment.
    • However, in most instances, unless there are “red flags” in the history or physical exam, an MRI scan is not necessary during the early phases of low back pain.
  • Bone scans are used to detect and monitor infection, fracture, or disorders in the bone. A small amount of radioactive material is injected into the bloodstream and will collect in the bones, particularly in areas with some abnormality. Scanner-generated images can be used to identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
  • Blood tests are not routinely used to diagnose the cause of back pain; however, in some cases they may be ordered to look for indications of inflammation, infection, and/or the presence of arthritis. Potential tests include complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Blood tests may also detect HLA-B27, a genetic marker in the blood that is more common in people with ankylosing spondylitis or reactive arthritis (a form of arthritis that occurs following infection in another part of the body, usually the genitourinary tract).

What treatment options are there for leg pain and symptoms from the back?

A/ Conservative Management including exercise:

Physiotherapy is an excellent choice for conservative (non-surgical) management of your back and leg pain symptoms

Physiotherapist’s are highly trained medical practitioners.

myPhysioSA Adelaide and Mount Barker have a team of Spinal Physiotherapist’s.

myPhysioSA Physiotherapist’s Tim Bass, Matthew Ash, Cameron Dickson and Deb Wadham, and Exercise Physiologist’s Courtney Wharton, Lara Watts and Jack Elsworthy have all completed specialised training with Neurosurgeon and Spinal Surgeon Mr YH Yau, interventional radiologists, psychologists, pain specialists and other specialist physiotherapists from interstate and overseas.

How do myPhysioSA Spinal Physiotherapists help?

Physiotherapists trained in spinal conditions are experts in the assessment and treatment of movement. Often patients with a spinal condition have maladaptive movement patterns that are significantly contributing to their pain. Changing these movement patterns using a multi-disciplinary approach has been shown in recent research to be very effective in improving patient’s symptoms (O’Sullivan, 2005).

Read more about our Spinal Physiotherapy services in Adelaide here:
https://myphysiosa.com.au/spinal-physiotherapy/

B/ Medication is commonly prescribed to help manage low back pain

Pain Medication Options by Neal Fitton, Mount Barker myPhysioSA Physiotherapist

There are many types of pain medication. In general, all pain medications are referred to as ‘analgesics’. Some analgesics are better for a particular problem then another. With all these different types of pain medication it can be difficult to know what medication works the best for a particular condition.

Therefore, this blog will give some general advice about the most common analgesic and what they are used for. This blog is not giving medical recommendations, rather it is providing general information. Medication is only one way to manage pain and usually can be enhanced by using physical and/or cognitive therapy.

Analgesic Pain Medications

So one of the most common analgesic is Paracetamol (eg. Panadol, panama etc). This medication has been shown to be effective for mild to moderate pain. It is typically used for headache and generalised pain. It also has a fever reducing capability. Paracetamol works by reducing the nerve signals sent to the brain.

Opioids are a stronger form of analgesic (eg. Vicodin, Oxcycodone, Codeine). These drugs are typically used for moderate to severe pain. Opioids work by binding to opioid receptors in the brain and spinal cord. Our bodies can also form its own natural opioids, called endorphins. Opioids reduce pain by reducing the nerve signals to brain. They also effect the regions of the brain that control emotion.

The body can develop a dependence on opioids in just a few weeks. Opioids have significant side effects including sedation, and reduced breathing rate. Because of these factors opioids are a prescription medication that are given cautiously and need to be taken under medical advice.

Anti-inflammatory Pain Medications

NSAIDs (Non-steroidal anti-inflammatory) are commonly used to manage pain relating to inflammation. Therefore, these medications work by changing the body’s response to swelling and pain at a local tissue level. These drugs are effective for muscle strains, and sprains, arthritis, and back or neck pain.

There are many types of NSAIDs.

Common NSAIDs include aspirin, voltaren, nurofen and ibuprofen, which are available over the counter at Pharmacies. Your GP can also supply prescription anti-inflammatories such as Mobic, celebrex, naproxen or stronger voltaren or brufen tablets.

NSAIDs are generally safe in short periods. However, long term use may cause issues with your stomach and liver. Most importantly, NSAIDs should always be taken under the direction of your GP.

Nerve Pain Medications

Nerve pain (also called neuropathic pain) is different from other types of pain. It is typically a result of damage to the peripheral or central nervous system. Common conditions where people experience nerve pain include shingles, diabetes, stroke, and HIV. Typical pain medication has little effect, however, low doses of medication that are used to treat depression and epilepsy have been shown to be effective. Typically, a combination of medication is used.

Anti-depressants are normally used when other analgesic have not been effective. They work by reducing pain signals sent to the brain. They also correct the imbalance of chemicals in the brain (noradrenaline and serotonin). Amitriptyline (eg. Endep), a type of anti-depressant, has been demonstrated to be effective at reducing pain for diabetic neuropathy, facial pain and postherpetic neuralgia.

Pregabalin (Lyrica) is a type of anti-epileptic. It is used to treat damaged nerves in conditions such as diabetic neuropathy, stroke, spinal cord injury and multiple sclerosis. It has been shown to improve pain and sleep in some patients with diabetic neuropathy or herpetic neuralgia.

So what are the best pain tablets for back pain?

Matthew Ash, a Spinal Physiotherapist at myPhysioSA in Adelaide explains there is enough evidence to confirm that using anti-inflammatories (non-steroidal anti-inflammatories or NSAID’s) is the most effective medication to use for easing acute low back pain.

These can be used in the short term to reduce pain so you can get moving again.

You will need to consult your doctor or pharmacist to get further advice about the best pain tablets for back pain to see if they are appropriate for you.

C/ Injections and interventions

An injection of a steroid (synthetic cortisone) medication into the epidural space is called a foraminal epidural injection.

There are two types of these injections.

They both involve injecting steroid into the epidural space to decrease inflammation and alleviate pain. The main difference is that one spreads the medication into the back of the epidural space and along a more diffuse pattern, hitting multiple levels during a single injection. Alternately, a transforaminal injection spreads the medication into the front of the epidural space, and is more specific to certain levels and certain affected nerve roots.

These injection options use cortisone, which has a strong localised anti-inflammatory effect, to target where the spinal nerves are being irritated or compressed as they are coming out of the spine.

The injection can be useful in settling the local area and reducing leg symptoms, and occasionally low back pain as well.

Remember though, injections aren’t usually recommended prior to the 12-week mark.

The steroid medication begins to take effect in one to two days at which point you should start to see some benefit. The steroid will continue to improve with the peak effect occurring at about two weeks.

Thereafter, the effect will stabilize and should last several weeks to months.

Typically, the pain relief experienced from this procedure lasts 3-6 months, but there is significant variability from patient to patient and from one procedure to another.

https://discover-cpc.com/pain-management/patient-education-information/transforaminal-epidural-steroid-injection/

A GP or specialist may refer you for a steroid injection, but what is it?

A steroid, or cortisone/corticosteroid, injection contains a strong anti-inflammatory medication that may help to settle pain that is not changing with physiotherapy management or that is hindering you from completing an exercise program or functioning with daily life. A cortisone injection may be administered for certain conditions to relieve pain, such as for bursitis, mild trigger finger or low back pain, but injections of cortisone and an anaesthetic such as lidocaine can sometimes be used to confirm a diagnosis.

For example, corticosteroid injections given in the shoulder may reduce localised soft-tissue inflammation or bursal inflammation. Epidural injections in the lumbar spine are cortisone injections inserted into a specific location in the spinal canal of the low back by a specialist under X-ray guidance. These injections may help relieve back pain and sciatica. Epidural injections can also be given in other areas of the spinal canal to relieve upper back and neck pain.

How are they administered?

Corticosteroid injections are commonly delivered by a specialist under a guided ultrasound to ensure the correct structure is targeted. Corticosteroid, as well as a local anaesthetic (such as lidocaine), may simultaneously be drawn into a syringe, which is then inserted into the tissue where the solution is injected. The needle is withdrawn and a sterile bandage is applied to the injection site. At times the relief from a cortisone injection begins almost immediately after the procedure, but it can take up to 14 days for someone to notice a change in symptoms.

(Rare) Complications:

Short-term complications are uncommon but include:

  • Shrinkage (atrophy) of the subcutaneous fat/ tissues
  • Lightening of the of the skin at the injection site
  • Local infection
  • Local bleeding
  • Soreness at the injection site
  • Aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (post-injection flare)
  • Tendons can be weakened by corticosteroid injections administered in or near tendons. Tendon ruptures as a result of steroid injection have been reported

Long-term complications of corticosteroid injections depend on the dose and frequency of the injections.

With higher doses and frequent administration, potential/rare side effects include:

  • Thinning of the skin
  • Thinning of the cartilage
  • Ligament weakening
  • Tendon rupture
  • Arthritis due to crystallisation of the steroid
  • Elevation of blood pressure
  • Cataract formation
  • Thinning of the bones (osteoporosis)
  • Avascular necrosis or osteonecrosis

How Long Does A Cortisone Injection Work For?

A steroid injection can be used to help reduce inflammation in the short term, but for longer term benefit physiotherapy and active management strategies are most important. With some conditions, the symptoms of the condition recur after a few weeks or months. In this situation, another cortisone injection can be given, but risks of side effects increase with more frequent or regular injections.

Source: http://www.medicinenet.com/cortisone_injection/article.htm

To find out whether we can help you with your pain or dysfunction, before or after a steroid injection, contact us now!

David Wilson, myPhysioSA Physiotherapist Mount Barker

D/ Surgical Management (Discectomy and Decompression, Fusion)

Lumbar Discectomy and Decompression

Discectomy literally means “cutting out the disc.”

A discectomy is done anywhere along the spine from the neck to the lower back.

The surgeon reaches the damaged disc from the back of the spine. They need to cut through the muscles and bone.

The surgeon accesses the disc by removing a portion of the lamina (a section of your vertebra). The lamina is the bone that forms the backside of the spinal canal and makes a roof over the spinal cord.

Next, the spinal nerve is retracted to one side.

A variety of surgical tools and techniques can be used to perform a discectomy.

An “open” technique uses a large skin incision and muscle retraction so that the surgeon can directly view the area.

A “minimally invasive” technique or a micro discectomy uses a small skin incision. A series of progressively larger tubes, called dilators, are used to tunnel through the muscles.

Special instruments help the surgeon see and operate in a smaller space. A minimally invasive incision causes less disruption of the back muscles and may decrease recovery time.

Surgeons will recommend the technique most appropriate for your specific case.

For more detailed information check out the rest of the article here:
https://www.mayfieldclinic.com/pe-lumdiscectomy.htm

Lumbar Fusion Surgery

The below information and images have been taken from https://www.mayfieldclinic.com/pe-fusionpreparing.htm.

Spinal fusion is a surgery that permanently joins together one or more bony vertebrae of the spine.

Fusing the bones together prevents movement at that level, gives back the normal disc space between the bones, and helps prevent future damage to the spinal nerves and cord.

Spinal fusion is usually a ‘last resort” and done only if all other treatments have been explored.

It will not “fix” your back problem or provide complete pain relief.

It will stop the motion in the painful area of your spine allowing you to increase your function and return to a more normal lifestyle—though one that may not be totally pain-free.

Back pain usually responds well to physical therapy and exercise, so make sure you have done your bit towards a successful rehabilitation before considering surgery.

What you do before and after surgery can help get you back on your feet sooner. It’s important to have realistic expectations and prepare properly for your recovery.

What is spinal fusion?

At each level of the spine, there is a disc space in the front and paired facet joints in the back.

Working together, these structures define a motion segment.

Two vertebrae need to be fused to stop the motion at one segment.

For example, an L4-L5 fusion is a one-level spinal fusion. A two-level fusion joins three vertebrae together and so on.

Bones can be fused together by using your body’s natural healing process, using bone from another place in your body (autograft), using bone from a bone bank (allograft), or with the aid of cage devices.

For fusion to occur between two vertebrae, a bone graft is needed to serve as a bridge.

The bone graft must be placed in a “bed” where the disc nucleus has been removed and the cortical bone drilled to expose the blood-rich cancellous bone inside.

And lastly, the bone graft and vertebrae must be immobilized while the bone graft and bed heals and fuses.

The fusion area is often immobilized and held together with metal plates, rods, screws, or cages.

After surgery the body begins its natural healing process and new bone is formed.

After 3 to 6 months, the bone graft should join the vertebrae above and below to form one solid piece of bone.

With spinal instrumentation and fusion working together, new bone will grow around the metal implants – similar to reinforced concrete. See the below illustration.

What treatment options are there for LBP?

A/ Conservative management

Physiotherapy

Physiotherapy is an excellent choice for conservative (non-surgical) management of your back pain symptoms.

Physiotherapist’s are highly trained medical practitioners.

myPhysioSA Adelaide and Mount Barker have a team of Spinal Physiotherapist’s.

myPhysioSA Physiotherapist’s Tim Bass, Matthew Ash, Cameron Dickson and Deb Wadham, and Exercise Physiologist’s Courtney Wharton, Lara Watts and Jack Elsworthy have all completed specialised training with Neurosurgeon and Spinal Surgeon Mr YH Yau, interventional radiologists, psychologists, pain specialists and other specialist physiotherapists from interstate and overseas.

How do myPhysioSA Spinal Physiotherapists help?

Physiotherapists trained in spinal conditions are experts in the assessment and treatment of movement. Often patients with a spinal condition have maladaptive movement patterns that are significantly contributing to their pain. Changing these movement patterns using a multi-disciplinary approach has been shown in recent research to be very effective in improving patient’s symptoms (O’Sullivan, 2005).

Read more about our Spinal Physiotherapy services in Adelaide here:
https://myphysiosa.com.au/spinal-physiotherapy/

Trying to decide what the best choice is to ease and help back pain?

Sick of taking pain killers and missing out on doing things that you used to enjoy?

So what actually does a Physio do to help back pain?

Matt, a Spinal Physiotherapist, explains what a Physio does and what questions they will ask. Then he shows how they examine your back and what treatment they are likely to do.

We made this video to help people with ongoing back pain have more information about Physio is. And what to expect if they decide to see one.

A myPhysioSA Physiotherapist will listen to you and work out what we need to get you back doing again. We then fully examine your back and explain what we recommend you need to do to get back on track fast.

Your treatment is based on identifying the cause of your problem and then using “Hands-on” soft tissue and gentle spinal Physiotherapy techniques, along with movement re-training and specific rehabilitation exercises.

Communication is key to everything we do! We listen to you, explain what we have found with our assessing, write it down for you in plain English you can understand, decide with you the fastest and best way to tackle your problem.

7 ways to Ease Low Back Pain

simple & effective advice by myPhysioSA

If you are in the EARLY STAGES, this is how you can start to ease Low Back Pain (up to 12 weeks):

  1. Relative rest from aggravating activities – While movement is encouraged, one should avoid overly-strenuous activities. Relative rest means carrying on with normal activities, including work and basic daily functions, as pain permits.
  2. Use ice or heat to ease your pain – either can be used for pain relief. Some people can tolerate ice on their low back; others prefer heat. Use what works for you!
  3. Use of an anti-inflammatory medication can be helpful in the first few days – seek medical advice first, to ensure that it is appropriate for you. Paracetamol has been shown to be ineffective for low back pain.
    • If you have had pain for many months or even years, here is some more advice to ease low back pain:
  4. Keep active – A patient who has had an active recovery, and done exercises diligently, should have very few limitations in life. Patients who have been mismanaged by their Physiotherapist, Chiropractor or GP and told to, “forget being active because it will make you worse” are more likely to have long-term issues
  5. Avoid relying on pain medications – Pain relief is just masking the symptoms. You need to be proactive and take control of your back pain. myPhysioSA will accurately assess your spine, test how you move, test the strength of your spine muscles, and prepare an individualised exercise program for you.
  6. See a Physiotherapist that understands chronic pain – Chronic pain is multi-factorial, so it is important that you are assessed correctly. After a good assessment, you will be able to have a clear idea of what you need to do to get better.
    • Our myPhysioSA Spine Physiotherapists have the extra skills, training and experience in dealing with your spine problem, they also work in Partnership with the International Spine Centre and the Hills Integrated Pain Team, giving you access to the best team in Adelaide to help you get back to what you loved doing again.
  7. Start GENERAL EXERCISES for your back pain
    • Try the following exercises. They are good way to keep your back moving.
    • Each morning, before you get out of bed, lie on your back and slowly stretch your arms overhead (being careful to avoid any fast, jerky movements).
    • Low Back Pain
    • Gently pull your knees to your chest, one at a time.
    • Once you are standing, put both hands on your buttocks and lean back slowly as far as is comfortable. Repeat this 5-10 times.
    • Low Back Pain
    • It is important that you do not experience back pain during, or after, these exercises. If you do, stop them and seek advice from your myPhysioSA Physiotherapist.
    • *Images courtesy of Physiotec

Take Home Message

Don’t let back pain stop you from doing what you enjoy. If back pain keeps recurring or becomes chronic, take control.

Stay positive: low back pain rarely persists with correct management. Keep active, and don’t let pain start to rule your life and all your thoughts.

Try the above starter exercises until you can see your myPhysioSA Spine Physio for an individualised exercise rehab plan.

myPhysioSA Spine is the Physio clinic in Adelaide to help your low back pain.

Wondering whether getting a back brace is the best way to help your back pain?

Do back braces work & what type of brace would be best for me?

Tom Peters, a Spinal and Sports Physiotherapist from myPhysioSA in Payneham Adelaide, answers all these questions and more all about back braces. A must watch video!

Exercise

Getting your spine moving normally again will greatly improve your ability to get back to your activities again. It also helps to reduce your pain and to help trust your back again.

We have lots of advice and instructions on back exercises below, just read on below.

Pacing

Learning to pace your daily activities is crucial in helping to manage back pain.

If you overdo certain aggravating activities, then your pain will spike. If you keep doing this, you will start a Boom-Bust cycle and will likely decide to cease most of your activities. This will decondition you and lessen your tolerance to activities.

Listen to Mat Ash as he explains why and how to use pacing strategies for helping better manage low back pain.

B/ Medications

Take Home Message

Medication can be a useful tool to manage pain. However, it is only one way to manage pain and can usually be improved by using physical and/or cognitive therapy.

Taking the right type of medication is important to provide the best pain relief. This means that before taking any medication it is important to consult your GP.

There are many types of pain medication. In general, all pain medications are referred to as ‘analgesics’. Some analgesics are better for a particular problem then another. With all these different types of pain medication it can be difficult to know what medication works the best for a particular condition.

Therefore, this blog will give some general advice about the most common analgesic and what they are used for. This blog is not giving medical recommendations, rather it is providing general information. Medication is only one way to manage pain and usually can be enhanced by using physical and/or cognitive therapy.

Analgesic Pain Medications

So one of the most common analgesic is Paracetamol (eg. Panadol, panama etc). This medication has been shown to be effective for mild to moderate pain. It is typically used for headache and generalised pain. It also has a fever reducing capability. Paracetamol works by reducing the nerve signals sent to the brain.

Opioids are a stronger form of analgesic (eg. Vicodin, Oxcycodone, Codeine). These drugs are typically used for moderate to severe pain. Opioids work by binding to opioid receptors in the brain and spinal cord. Our bodies can also form its own natural opioids, called endorphins. Opioids reduce pain by reducing the nerve signals to brain. They also effect the regions of the brain that control emotion.

The body can develop a dependence on opioids in just a few weeks. Opioids have significant side effects including sedation, and reduced breathing rate. Because of these factors opioids are a prescription medication that are given cautiously and need to be taken under medical advice.

Anti-inflammatory Pain Medications

NSAIDs (Non-steroidal anti-inflammatory) are commonly used to manage pain relating to inflammation. Therefore, these medications work by changing the body’s response to swelling and pain at a local tissue level. These drugs are effective for muscle strains, and sprains, arthritis, and back or neck pain.

There are many types of NSAIDs.

Common NSAIDs include aspirin, voltaren, nurofen and ibuprofen, which are available over the counter at Pharmacies. Your GP can also supply prescription anti-inflammatories such as Mobic, celebrex, naproxen or stronger voltaren or brufen tablets.

NSAIDs are generally safe in short periods. However, long term use may cause issues with your stomach and liver. Most importantly, NSAIDs should always be taken under the direction of your GP.

C/ Injections and interventions

A facet joint injection involves injecting local anaesthetics and sometimes steroids into or around a facet joint. The local anaesthetics numb the nerves to the facet joint to give pain relief. The steroids reduce inflammation and may make the pain relief last longer.

A facet joint injection can be used to find out if your pain is caused by your facet joints, or to treat pain in your facet joints.

A facet joint injection usually takes less than 30 minutes. Your doctor may use an x-ray to guide them while they give the injection.

Your doctor will carefully insert the needle for the injection. They may inject dye (colourless contrast fluid) and take an x-ray to help them to check that the needle is in the right position. Sometimes your doctor will use an ultrasound scanner to help guide them while they insert the needle.

https://www.healthdirect.gov.au/surgery/facet-joint-injection

Facet joint radiofrequency denervation procedure

Facet joint denervation involves heating the nerves supplying the joints with a special needle with a tip that is heated via radiofrequency waves. This procedure is done after you have had a positive result from a diagnostic test injection such as a facet joint injection or medial branch block.

The facet joint sensory nerve is targeted and taken out of action so as it can no longer work. This will stop pain being felt from the involved facet joint. The nerve will slowly repair over 6 to 12 months and again supply sensation to the facet joint again.

This denervation procedure can give great relief from facet joint pain over 3 to 12 months in most people.

D/ Surgical management (Fusion, Decompression, Discectomy)

Decompression surgery or laminectomy is when a small piece of the bone is removed from the vertebra to allow more space for the nerves. This can take pressure off the nerve structures and relieve pain in a person’s leg/s. It is often indicated when bone is the cause of a reduction in space for the nerves. Sometimes it is done at the same time as a discectomy where both are required.

Discectomy surgery is when a small piece of the disc material that has herniated to the side is removed to allow more space for the nerves. This can take pressure off the nerve structures and relieve pain in a person’s leg/s. It is often indicated when disc material is the cause of a reduction in space for the nerves. Sometimes it is done at the same time as a decompression where both are required.

Lumbar Fusion is where metal work is screwed into the spine to stabilise the bones and relieve pressure on the nerves, allowing more space at this level. This is often an end stage operation when other interventions have failed or following a trauma or serious injury in which the spine has been damaged. It is important to follow up each patient who has metalwork to ensure bony fusion occurs and the metal work remains stable over the first 12 months

What is advised to do after having spine or back surgery?

Matthew, a Senior Physiotherapist working in partnership with the International Spine Centre, discusses the best advice on what you should be doing early on after surgery.

Matthews advice includes:

  • take your pain medications so you can get and keep moving
  • avoid prolonged static positions eg don’t sit or stand too much, keep changing positions
  • start a gentle walking program
  • get a graded exercise program set for you to improve your strength and conditioning

The advice is general and can be applied to any back or spine surgical procedure including; spinal fusion, laminectomy, discectomy, scoliosis surgery, removal of tumour etc.

The main take home message is to take your pain medications and start to get moving.

Matthew Ash, Senior Physiotherapist myPhysioSA Adelaide

Exercises for LBP

At myPhysioSA we love helping people.

Below is some of our best educational advice just for you.

Our clinical staff have done blogs and video’s that teach you simple and effective exercises for you to gently try. If these are helpful then a tailored program will help even more, so just get in touch.  If any of these exercises increases your pain then cease immediately and let us know!

A/ General Exercise

How to get your back moving again

Get professional back pain advice from our Partner Physiotherapist Josh Stewart from myPhysioSA, Adelaide, Australia.

Josh explains in simple terms about why it’s important to get moving again to help your low back pain.

Other key learning points in this video include:

  • The latest research tells us that it is important to get moving early and keep moving if you have low back pain
  • Start with safe gentle movements “non-sweaty movement”
  • How to start pacing activities
  • The truth about posture and back pain

Back pain with lifting or bending?

Is your lower back becoming sore while gardening or lifting? Lower back pain, strength for lifting, do’s and don’ts

Most people garden for enjoyment, seeing the beauty of plants and flowers grow, or to grow their own food. Gardening can also have a positive impact on your health. It improves strength and cardiovascular health, and promotes a sense of relaxation.

It can be quite an intense workout, and we often see people who developed back pain with lifting during gardening. For this reason, it is important to move well and build your strength to reduce back pain. Below are some functional exercises you can complete at home, that mimic the same movements as gardening.

Tip! If you don’t have weights at home, that’s okay! You can use household items such as buckets of water or bags filled with books, cans of food or empty milk bottles refilled with sand.

Deadlift

Start by standing with your feet either side of the weight. As you bend down think about the idea of a door behind you and trying to push it closed with your bum. As you stand up, pretend to squash a grape under the heel of each shoe and squeeze your buttocks together.

This exercise is great for building strength to lift bags of soil or pots, and bending to pull out weeds.

  • Progression
    • To continue to make the exercise harder, just increase the weight.
  • Regression
    • If it is difficult to reach the ground, you can pop the weight on a stack of books or pavers.

Squat

Start by standing with your feet flat on the ground. Push your hips back like you’re going to sit in a chair. Squat down as far as you feel comfortable, keeping your heels on the ground. As you stand up, push your heels into the ground.

This exercise is great for building leg strength so you can bend easier, and get up off the ground. It also strengthens the back to help reduce any back pain with lifting.

  • Progression
    • To make this exercise harder hold a weight on your chest. This will help to build your strength for carrying objects like pots, bags of soil or pavers.
  • Regression
    • To make this exercise easier try squatting to a chair. Start sitting in a chair. Place feet flat on the ground and stand up, without using momentum or your arms if you can.

Lunge

Low Back Pain

Start by standing with one foot half a metre in front of the other and slightly to the side, like you’re standing on railway track. Keep your front heel on the ground and your back foot can go on your toes. Lower yourself straight down (not forward) towards the ground as far as you feel comfortable and back up.

This exercise great building your lower limb strength and balance so you pick up pots or bags of soil, or lunge down to pull out weeds. Again helping with any back pain with lifting or bending.

  • Progression
    • If this is too easy try walking lunges. After you have done 1 rep step forward with the back foot and repeat. These are great for challenging your balance further.
  • Regression
    • If this is too difficult try a small step up instead. Focus on pushing through the leg that is on the step, and keeping controlled movement as you step down.

Row

Stand hinged over at the waist holding a weight in one hand, leaning on a waist high object in the other hand for support. Keeping your back aligned, straighten your arm towards the ground, then pull the weight towards your rib cage pulling your shoulder back, like you’re starting a lawn mower. Lower the weights back to the starting position and repeat.

This exercise is great for building your upper back muscles for pulling out weeds and starting the lawn mower. They are also great for building core stability.

  • Progression
    • If this exercise is getting easier try doing it without leaning on something for support.
  • Regression
    • If this is too hard tie an exercise band around a solid object. A veranda post or clothesline is a good option, and hold the ends in each hand. Stand with your feet slightly apart, keeping a good upright posture. Bend your elbows and pull the band back, squeezing your shoulder blades together. Return to the start position and repeat.

Woodchop

Hold a weight in both hands and stand up straight. Lift the weight high above your head to one side, then bring it down across the body, to the opposite hip. Just like you are chopping wood with an axe.

This exercise is great for strengthening the whole body. It helps build strength for rotation movements like pulling out weeds, whipper snipping or starting the lawn mower. It’s also great for building overhead strength to help when you need to keep your arms up high to trim those hard to reach places.

As this gets easier, try taking the weight lower down to your knee or ankle.

  • Regression
    • If this feels a little too hard, try lifting the weight just as high as your shoulder.
  • Practical tips!
    • Aim to complete 2-3 sets of 10, depending on what you can manage, 3 times per week. Is you get stronger try out the progressions, or gradually increase the weight you are using.
    • Let’s keep you gardening and reduce your back pain with lifting and bending activities!
    • Written by Courtney Wharton, Accredited Exercise Physiologist. Courtney works at myPhysioSA Payneham and Mount Barker helping people to better manage back pain. Courtney also consults at the International Spine Centre in Adelaide

B/Stretches

If you have a tight back, try these safe and effective stretches to help loosen your back and improve your mobility.

Ellen, a myCore Physiotherapist in Mount Barker Adelaide, demonstrates 5 of the best back stretches you can do. Ellen talks you through each stretch and explains what and where you should feel each stretch, and how long to hold your stretches.

Try these 4 easy to do stretches for your spine and hips every morning. 4 minutes is all you need! David, one of the Partner Physiotherapist’s at our Mount Barker clinic, demonstrates each stretch and explains where you should feel each stretch.

Tight low back or flank muscles? Try these three targeted back muscle stretches. David, a Partner Physiotherapist at myPhysioSA, demonstrates and explains how to do each stretch.

Do you get back pain with sitting? Try this easy seated stretch to relieve you tight back muscles.

Physio David explains how to do this simple stretch that can really help you to manage back pain with sitting. myPhysioSA Adelaide: Payneham & Mount Barker.

If you sit a lot, then you could get low back stiffness and pain. Watch Tom Peters, a myPhysioSA Sports Physiotherapist, demonstrate four easy to do stretches at work or home that can really help.

Tom shows you how to stretch your tight low back muscles, mid back, glutes and hip flexors.

C/ Functional Strengthening

Josh gives the best starter exercise to activate your back, hip and core muscles that you can start doing right away to help low back pain.

Learn about the latest Physiotherapy advice for how to better manage your low back pain. Use these tips starting from today and get on top of your pain.

How to Carry/Lift Objects with a Strong Core

Core is one of those terms that more and more people have become aware of over the past couple decades.

There is vagueness about the term however, and although many understand that it is desirable to have good core, they are not quite sure what a good core is.

A not uncommon statement/question I hear in the clinic is something like “I know I need to work on my core” swiftly followed up by, “what exactly is my core and how do I strengthen it?”

This is a good place to start. Firstly “strengthening” core is a little too simplistic.

Although the process of improving your core does not have to be difficult, there are more factors involved in developing a good core than just strengthening some muscles.

Put in a simplified way, core literally involves the area around the centre of your body.

It encompasses your pelvis, vertebrae, ribs, muscles and all the associated connective tissue. In relation to the muscles, generally speaking the deeper layers should be good at working at a low intensity, over long periods, helping to stabilise your joints and internal organs via your connective tissue.

The superficial layers of muscle around your centre are more concerned with moving your centre, but also stabilizing it for short durations when greater forces are involved. Therefore the muscle part of your core works best when you have the right combination of muscles working and relaxing at the right time and with the right amount of strength and endurance to do the movements you want to do.

Back to our question of how having a good core makes it easier to lift and carry things.

By having a good core, it allows you to be able to lift things using your arms to leverage of this stability.

Similarly when you are carrying things, the dynamic stability offered by using the right muscles with the correct timing, allow you to move the load in the most efficient way. A bit like the counter weight of a crane allowing the arm of the crane the stability it needs to move. Having sufficiently stable and flexible vertebrae, pelvis and ribs and their associated joints will give you the capacity to stack your frame in the most efficient postures before and during your lifting and carrying.

This essentially makes a given task easier work on the rest of your core system. Of course the huge benefit of this more efficient system is that it is easier on your joints and soft tissues.

The best way to improve your core in a word is exercise.

Generally the best kind of exercise to do is the one you are most likely to enjoy and therefore consistently do.

However as you see from the description above core is multi-factorial. We tend to have really good core as kids and many adults naturally retain good core.

Unfortunately as we age and go through certain repetitive movements, postures, traumas and episodes of pain, different parts of the core system can become sub optimal. The parts affected are individual.

Consequently if exercise alone has not helped you to do the things you want to do, the way you want to do them, or if you just want to get there more quickly then book an appointment with us at myPhysioSA.

We can find out which elements of your core system need improving and help you improve it in a more targeted and efficient way.

Anthony Sheridan, myPhysioSA Associate Physiotherapist Mount Barker Adelaide

Do you do any of these best advanced 5 core strength exercises?

If you don’t, then you should give them a try.

Make sure you think about activating your deep core first, before you start each exercise.

Try doing these exercises daily. No pain allowed!

Abdominal Plank

Place the forearms on an elevated surface.

With the elbows directly under the shoulders, prop yourself up on the elbows, keeping a neutral back and head aligned with the spine.

Hold the position for up to 1 minute.

Partial crunch

Lie on your back with your knees bent and your feet flat on the floor.

Tighten your stomach muscles and flatten your back against the floor. Tuck your chin to your chest. With your hands stretched out in front of you, curl your upper body forward until your shoulders clear the floor. Don’t hold your breath. It helps to breathe out as you lift your shoulders up.

Lower back your head and shoulders.

Build up to 20 repetitions.

Reverse Crunch

Lie on your back with your legs straight up in the air and your feet together.

Push your feet up towards the ceiling and lift your buttocks off the ground. Lower your buttocks.

Build up to doing 20 repetitions.

Wood chops

Stand in a lateral split stand.

Tie an elastic high up to one side of a door.

Hold the elastic tightly with both hands at shoulder level with your shoulders back and your weight on the leg closest to the door.

Transfer your weight to the other leg, rotate your trunk using your abdominals and upper back and pull the elastic towards the floor.

Slowly return to the initial position with control and repeat.

Build up to doing 20 repetitions.

Bow and arrow

Stand up with the extremities of a band in your hands. Your body should be turned sideways facing the band anchor point, with one foot and the same-side hand forward.

Pull the band with your back hand and push/reach forward with your front hand in a reciprocal movement.

Repeat up to 20 times each side.

* Please make sure all these exercises are easy to do and are pain free during and after. Stop doing them if you feel any discomfort.

At myPhysioSA we love setting our clients up with customised targeted strength and conditioning programs, either in our Fitness Studios or as home programs.

If you are not sure the above exercises are exactly what you need, then book to see one of our Physio’s and get your customised program on track now!

David Wilson
Partner Physiotherapist

All images courtesy of Physiotec, exercise software.

Exercises for leg pain from the back

Here’s some of our best advice and tips that you can try that may be useful to help your leg pain that is coming from your back:

How to do a nerve stretch

Matt, a Spinal Physiotherapist, teaches how to ease leg pain using nerve flossing stretches

Doing a nerve stretch is gentle and easy to do.

Nerve stretches can be very effective for helping sciatic nerve pain that is coming from your low back.

The first nerve stretch is called the slump nerve flossing stretch, and is performed sitting up. The second option is to do the active knee extension flossing stretch laying on your back. Both are equally as effective, just pick which version suits you best.

Ensure you have no symptoms whilst doing the stretches, they should be gentle and pain free. If they ease your pain, then do them regularly. Some people use these stretches up to 4 times per day to relieve their leg pain that is coming from their low back.

Do these stretches slowly and build up to doing ten repetitions each time.

Sciatic nerve pain is common and the good news is that it’s usually will go away quickly. Leg pain doesn’t mean there is anything damaged or seriously wrong with your back.

I have seen a spinal surgeon and they have recommended surgery, what should I do now?

  • When to seek a second opinion
    • You should always feel confident in any specialist that you see and their recommendations and explanations should make sense. This is also important when seeing a spinal specialist or surgeon. They should explain to you about your symptoms, why you have them, any scans you have had and any findings on their examination.
    • If you do not feel comfortable with the specialist you see or you are still unsure, then you can always seek a second opinion by asking for a second referral to another specialist from your GP.
  • Pre-operative education and conditioning
    • Outcomes following spinal surgery often can be maximised by your preparation pre-surgery.
    • We would recommend that you attempt to stop smoking as this can delay healing following surgery. Also try and increase your general fitness and strength prior to any spinal operation.
    • This will give you a distinct advantage when commencing your post-operative rehabilitation and you will get up and going quicker from day 1.
    • You may also be asked to stop or reduce some medications you are taking to prevent any excessive bleeding or blood loss during surgery.
    • Another useful tip is to have a pre-operative physiotherapy appointment so that you can have the rehabilitation protocol explained and you can prepare both physically and psychologically for the surgery ahead.
    • Learning about pain and pain management has also been shown to be very useful before undergoing any operation, including spinal surgery.
    • There are a number of good resources on the internet and talk to your myPhysioSA spinal physiotherapist about these when you attend the pre-operative appointment.
  • Post-operative management
    • Following most spinal operations you will see your physiotherapist every day you are in hospital. In most cases you will sit on the edge of bed and start to do a small walk day one following your operation.
    • This has been shown at assist in minimising complications and also improving long term recovery outcomes.
    • You will also be instructed on some basic home exercises to complete each day over the first 2-3 weeks.
    • These exercises will depend on your operation and the recommendations of your surgeon.
    • Following discharge from hospital we recommend that you are regularly reviewed by your spinal physiotherapist. This allows them to monitor you and progress your rehabilitation program and exercises regularly.
  • Return to work and activity
    • Setting goals is also important for patients and will determine the goals of your rehabilitation.
    • Some people want to return to work, sport or just something that they really like doing again, like walking, dancing or gardening.
    • Goals are individual and will depend on the patient. Most patients who have a desk job will be able to return to work around the 4-6 week mark post lower back surgery but may require to do shorter days to start off with depending on discomfort.
    • Following neck surgery this is likely to be 2-4 weeks later as sitting for long periods may be uncomfortable.
    • Returning to hard, physical work will be longer due to the nature of the work.
    • Also after having lumbar fusion patients will likely take a little longer to return to work.
    • Returning to sport following surgery is possible but usually takes 9-18 months depending on the sport, recovery and rehabilitation.

What can you do to give yourself the best chance of not developing LBP?

  • Control your weight
    • every kilogram of extra weight you carry, especially around your waist, can have an impact on managing your back pain
  • Sleep
    • sleep is your bodies chance to recover and heal.
    • Men need at least 7 hours sleep and women 8 hours
  • Activity level/exercise
    • keep yourself active during the day. Prolonged sitting and/or standing over the day means you are moving less in the day. Motion is lotion for your body. Keep moving regularly.
  • Reduce and manage stress
    • stress impacts your body in many ways, including your immune system, moods and weight.

Low Back Pain Summarised

Sprains and strains of the muscles and tissues around the spine are the most common cause of low back pain. However, the truth is that we usually cannot pin point the exact structure or cause for low back pain.

We are all designed with protective mechanisms to look after our body when there is danger to the tissues. If you hurt your back, it is normal to experience some pain and protective muscle guarding, which often changes our postures and how we move.

Everyone is different, so recovery times are going to vary from person to person. At lot of minor low back sprains & strains will settle down over a few weeks; however, they can take up to 12 weeks to settle in some cases.

We know in most cases of back pain the spine itself is strong & sound, and does not need to be ‘protected’ further by avoiding movement and activity.

It is widely accepted that complete rest is unhelpful when managing low back pain, whether that’s following an acute injury of with more persistent pain.

In the first few days after an injury, it is better to reduce and modify your level of activity, however keep moving and stay as active as you feel comfortable.

A recent systematic review from 2016 in the American Journal of Neuroradiology has shown that it is normal to experience changes in the lower back with age, just like getting some wrinkles or grey hairs on the outside.

So in most cases suggestions of ‘disc degeneration’ or ‘disc bulge’ that show up on MRI or CT scan are likely due to normal changes with age but don’t necessarily provide any helpful information about why you may be in pain.

Any scan results need to be consider in context with the overall clinical picture.

In summary:

Low back is common and it usually gets much better over 6-12 weeks.

Be positive and keep moving as tolerated.

Our team of Physiotherapist’s Exercise Physiologist’s at myPhysioSA are here to help!

Finally, check out the below FACT SHEET by the NPS for a great summary: