By: Heather Imrie from Rebalance Sports Medicine, in Toronto.
What are the common causes of lower back pain?
Pain coming from your low back can originate from a number of structures, including the discs between the vertebrae, the joints and muscles of the back, pelvis and even hips. Pain is caused by dysfunction and subsequent inflammation/irritation of these anatomical structures which are often brought on due to movement that involves bending, twisting, prolonged sitting or lifting in combination with one of these two things:
- Inefficient Body Mechanics and or Posture. This can be in a static posture such as sitting or a dynamic movement such as bending to put on your shoe. When you leverage your movement from less mobile joints and the muscles surrounding that area are not up for the challenge you can easily strain the secondary structures such as the innervated disc, joint capsules or even compress the joint surfaces themselves. Making sure you are moving your body the way it was naturally designed to work will decrease the likelihood of an injury.
- Muscle Imbalances: this can occur when our lifestyle, sport or training methods are not balanced. One of the most common things I see when it comes to lower back pain is weakness in the core and stabilizing muscles of the spine, pelvis and hips while bulk and strength of the big muscles like the latissimus dorsi, erectors etc. The small muscles stabilize and protect joints and ensure optimal movement, it is the base for the big muscles that move multiple segments.
Another common occurrence is having a lack of flexibility/mobility, such as tight posterior chain (muscles down the back body) or hip flexors and which continues with the focus on just resisted strengthening for hypertrophy (muscle size) and not balancing this with core and flexibility routine.
2. What can people in high-demand, but sedentary jobs do to reduce the risk of back pain?
- A daily spinal mobility and low impact core exercise routine.
- Stay active outside of work. Train effectively and with good mechanics. Become educated by a personal trainer or physiotherapist to ensure you are recruiting your core as you perform complex dynamic movements at the gym or in sport.
- During your workday, move often and utilize ergonomic equipment like a sit to stand desk. When you feel an incline in your body to move, move it!
3. What are the most common mistakes that physiotherapists make when treating back pain?
Treating just local to the pain and not looking at the function of the system as a whole. The hip, pelvis, upper back and even shoulders can contribute to lower back pain so they need to scan these areas to ensure they are not part of the cause.
Getting caught up on classifying and communicating a specific diagnosis. What we call an injury is not important, it is how we describe it is occurring and how we are empowering our patients to understand what they can do (with our help) to resolve it.
In keeping our diagnosis more non-specific we can decrease the perception of how serious the injury is to the patient and not create added stress. This is also important when a patient has imaging such as an X-ray or MRI. All spines 30+ will have some form of findings on these tests but only going off this as a diagnosis is a mistake. The human body is adaptable and will change day to day. Your treating professional should be looking at the whole picture and evaluating and reevaluating your movement patterns every session, their diagnosis may evolve and that is actually a sign of a good therapist.
Another common mistake is underprescribing treatment. A good therapist will have your pain decreasing within the first few sessions. However, it is really easy to let patients leave satisfied as soon as the pain has disappeared but that does not mean that you have followed through on addressing the actual cause and in a few short months the pain will likely return. If you truly want to get someone better and self-managing their injury, a care plan for lower back pain should last 2- 6 months, with treatments more frequently at the start and becoming less frequent over time. Similar to working with a personal trainer you can’t get long term results with just a few sessions. This is a process and you need your professional support to guide you through it.
What’s your approach?
I always take time to get to know my patients. The first time you meet me I will not just jump right into treatment. I go on a fact-finding mission where I listen, ask questions, and really put myself in my patient’s shoes to understand what they are feeling in their body and understand how it is impacting their life. I may also share tidbits of small, immediate lifestyle changes you can start implementing right away that could make a big change to your recovery. I will always be honest with my feedback and remain encouraging throughout the process.
I’m a FCAMPT (Fellow of Manual and Manipulative therapist) this means I have spent several years developing my hands-on skills to achieve this accreditation. When I start observing how your body is moving I can quickly hone in on the areas that are moving too much and the other areas that are moving too little. The areas that are moving too little will get some hands-on mobilization or manipulation if it is indicated. The areas that move too much will get protection by educating you how to avoid straining into these areas and starting some local stability exercises.
I also utilize dry needling or Gunn IMS with almost all my patients. It is a great way to impact the neuromuscular system, the effects can be almost immediate and really take the pressure off the stressed areas of the body.
Lastly, all treatment plans I create include movement education. I really like to start with the basics of how to recruit your core and maintain spinal posture (almost all injuries need some version of this). I would also review and watch you perform some of the movements you do frequently but would relate to your injury. This could be something like bending down to pick up your little one, to a deadlift in the gym.
It is important to note that every body is different and has its own movement limits, strengths and weaknesses. When injured, you’ve gone beyond this and stressed the system. However, it is adaptable, good treatment, mindful movement, a healthy lifestyle (nutrition, hydration and sleep) that will have you feeling good if not even better than before but you have to have your health care and movement specialists’ team behind you and not just Dr./Trainer Google.