- Does your back hurt when you sit for long periods?
- Does your back feel sore to get up from being seated for a while?
- Does your back hurt to get out of bed in the morning?
- Does it hurt to tie up your shoe laces?
- Does pain shoot down your leg or into your butt or get worse when you cough?
- Does it hurt to slouch?
- Does it hurt to arch your back or sit up straight?
If you answered “yes” to more than two of these, you are not alone.
The question is… How do “you” get it better?
- Should you have massage before manipulations?
- Should you have manipulations before massage?
- Should you do stretches to loosen things off?
- Or should you strengthen to stabilize the area instead?
These are the same questions our clients ask us all the time….
- Do you get back pain, and then try to get the knots worked out, just to have them come right back?
- Do you find that deep tissue work will help for one or two days and then your pain comes right back with a vengeance?
- Or you have your back adjusted or manipulated and it feels great for a day or two, only to have the pain or spasm re-occur if not worse that before?
We want you to Stop throwing time & money away at treatments that are not tailored to “you”.
- The big question is, ‘what is actually wrong with your back!?
- Has your practitioner assessed your back fully and told you what is wrong & how your unique case is going to get better?
All treatment plans are individual. All back injuries are different.
If you want a therapist to tell you the silver bullet “canned” answer to all back pain – we can’t.
There is no “one” way to solve your problem, there is however “a” way to solve your back problem.
Some questions we ask to figure out what is wrong are:
- How did you hurt it or has it come on slowly over time?
- How does it act… sharp, achy, shooting, or numb etc and what makes it worse or better?
- What treatments have you had and what helped (this can give us a clue by how the tissue responded to certain treatment).
- Does it hurt more to bend forward or to arch back?
- Does it hurt more to side bend or rotate?
- Is it worse when it’s cold or worse after working?
- There are numerous questions that must be asked to next identify what tests to do and what your injury “actually” is.
Next, is to assess your back and piece together:
- how you feel, with
- what is found to be “structurally” wrong, and how it is moving, or not moving.
After a thorough assessment & diagnosis is made we can move forward with a very specific plan for “you”.
Here are a four things we may find wrong:
A muscle Strain could have been your injury, causing your joints to be pulled out of their normal position by the tight spasm-ing muscles. Stretching and working on the soft tissue will be more successful than joint manipulations. “Cracking” your back into place in this case will be a short term fix. You need to have your therapist work on the root cause of the problem to get the the tension off the muscle that was injured to allow the joints to move properly. Then, once the scar tissue or spasm has been corrected, an individualized strengthening plan should be developed for you to get the muscles working and strong. The back muscles contract and hold your posture all day and therefore they need to have good muscular endurance to safeguard you from re-injury. They need to be stronger for those who work physically (firefighters, farmers, weight lifters, nurses, moms…) and have specific re-training based on the work you do. If a muscle strain has gone without treatment for too long, it could pull the joints out of alignment for long enough causing them to need to be mobilized to get them moving as well. Back flexibility is important but strength is critical. Core work and planks are a brilliant way to strengthen and protect a back!
A joint Sprain could have been the injury originally in your lumbar spine or Sacroiliac Joint ligaments. If this occurs, the area or ligaments may over-tighten or scar down after the sprain, “or” heal unstable (loose) from more substantial tearing of the supporting structures. Back muscles will then spasm as a natural protection mechanism to the injured area, indicating that the body is protecting something. The spasm originally is useful to help the area heal properly and be protected. After awhile the spasm can prove to be a concern. If the pain is not settled and the joint motion is not properly restored, the spasm will keep coming back. In this case, you need to know that the area healing properly, or that it is healing too tight or too loose. You may need mobilizations or you may need stabilization training, or even a brace. Working out the muscle spasms may be enough to restore joint motion, other times you need to very specifically mobilize/manipulate the joints. Worse, what if the injury mechanism was bad enough and your sprain actually involved a fracture as well. In which case – ongoing protective muscle spasms can be a true sign of warning. Your therapist will be able to evaluate if an Xray is needed and/or work with your doctor to decide. If your back injury warrants an Xray/MRI or CT scan, your physician will ultimately decide and coordinate this imaging to rule out fracture or dics herniation, allowing the treating therapist to do manual therapy as indicated & provide rehab direction specific to your case.
A DISC herniation could have been your injury. Your practitioner will be able to assess for this too and imaging may be needed – but not in most cases. If you have certain signs that a disc (spongy stuff between the vertebrae) has herniated (ruptured or blown or slipped or bulged), then your practitioner will decide if it is urgently needing to see a surgeon or if you need to be on a conservative plan. I myself have herniated a couple discs in my back through injuries I had, and both times they resolved – but took over a year. The pain, spasm and numbness I experience made me feel like I needed urgent surgery. This is common and our clients as well get very worried and impatient. The majority of disc herniations are non-surgical and recover with time (as the disc bulge recedes) or with an appropriate treatment plan to reduce disc pressure. Again – getting your specific back looked at will tell you how to proceed. Some disc injuries necessitate urgent care in order to reduce chances of permanent nerve damage. These usually involve constant unrelenting symptoms and see little change at any point in the day.
Birth defects or Congenital issues may be your issue. If you have back pain that starts early in life and seems to be progressing you may have a fracture defect or congential malformation. Some things like scoliosis (curved spine) or spondy (fracture or defect in L4 or L5) called a spondylolysis or spondylolisthesis are things that could cause you problems but are not necessarily a reason you have pain your whole life. What I mean is not everyone (in fact most people) that have scoliosis or a spondy have back pain. Therefore – a diagnosis of scoliosis does not mean you will have back pain. Some people have moderate scoliosis and experience no back pain at all. Similarly, some people have poor winter tires – but never get in an accident. So, to have someone say… ahhhh you have scoliosis… that’s why you have pain, is not a good answer to your problem. More than likely you have had the “birth defect” for a long time… (however old you are), but why are you “now” having pain?? So you could have sprained your back like anyone or injured a muscle and simply need that treated. A congenital defect could make you more at risk for injury or pain and it is important to get it assessed and know for sure. I always say “the person with worn out snow tires can still blow their transmission”. It is unethical to say… “ahhh you have back pain because you have scoliosis”. It’s like saying you had a crash in the winter because you have all-season tires. It could also be because you are a poor driver or there was fog? Ok, so a congentital back defect could come in many ways and be a true indication of your pain, and also, having a decfect or malformation can indicate a treatment plan to limit pain or potential progression of your injury. There can also be an aggravation or abrupt change to a pre-existing injury (something you were born with), and later in life you can start to feel the effects of it due to natural progression or due to poor movement patterns.
Either way, a thorough assessment will hope to get it figured out & give you very specific things to avoid and do to help out.
By Melanie Tuck – Certified Athletic Therapist (Collegiate Sports Medicine, Red Deer AB)
Call to get your back assessed today 403-314-4458