Back pain recurrence and what to do about it.
To understand why back pain recurrence occurs, we need to first look at what causes injury in the first place.
Back pain generally stems from some form of trauma that has occurred or loading placed on your back repeatedly over a period of time.
In a healthy functioning body, deep abdominal or ‘core’ muscles assist in the control the spine and allow an even distribution of load throughout the appropriate tissues. However, with a sudden injury or poor long term biomechanics, control of these muscles is reduced. From this point the back is less able to withstand load placed upon it and there is a greater chance of further trauma in the future.
This trauma may cause damage to the tissues within your spine including the disc, joints and muscles. Once your back has been subjected to trauma the damage sustained may alter the structure of your spine, including arthritis within the joints, disc disruption or bone alignment.
Physiotherapy treatment aims to alleviate your pain and then ultimately regain a full range of movement whilst preventing further damage to your spine. Treatment is essential to reach these goals but it is also important to determine why the injury occurred in the first place. Understanding the root cause can help ensure that the same incident is not repeated and assists in the long term management of your back pain.
Tactics to keep back pain recurrence at bay
So here are some of the most important management areas.
Optimising back function
The spinal column is vulnerable at it is long, thin and has attachments to the other major structural components within your body. There are many different muscles which attach to it and these muscles can pull each individual spinal segment in a different direction. Correcting these body mechanics and postures are vital in allowing future loads to be safely distributed throughout the spinal column.
Those with back pain will often be overactive in particular muscle groups and under active in others, particularly their ‘core’ muscles. Your physiotherapist is likely to discuss options for improving this and may make alterations depending on your particular posture.
It is important that following your treatment your continue to maintain the alterations that the physiotherapist has made. For example this may mean continuing with stretches and specific strengthening exercises as a long term routine to prevent the back reverting to a previously unwanted posture.
Changes to how you work or exercise is often required to prevent re-injuring your back after your injury. Most people will have specific movements or activities which will cause them pain during the recovery from a back injury. It is important to take note of these activities and understand why they are painful so that once your pain is gone you are still aware of activities which are most likely to cause you pain in the future.
You may need to modify these activities to prevent ongoing loading of your spine in a particular way, such as changing your work setup so you don’t have to lift from the ground repetitively or altering your desk setup so you can sit or stand during the day to prevent stiffness and slumped spinal postures.
And it is important to remember, that whilst you don’t have pain currently, factors that contributed to a back injury in the first place are likely to be the contributing factors in the recurrence of an injury.
Contributing factors to back back pain are not always evident yet something as simple as losing excess weight will obviously reduce the load on your body. By monitoring food intake, making healthy food choices and stopping habits such as smoking, you can contribute to the overall effort of a healthier back. Even the clothes or accessories you wear can interfere with your efforts to have good posture, such as tight clothing that restricts squatting when lifting or bag that is hard to carry because it is without a shoulder strap.
Being more aware of how you lift, will set you up for future success. There are several ways to pick up items and these can be included into your exercise routine. That way, when you do need to use them in a practical manner throughout the day, your body will be trained to move correctly. These are some lifting techniques that we recommend.
As such a large proportion of your life is spent in bed, sleeping in the correct position is vital in the care of your back. It is important to maintain a neutral spinal position, where your spinal is relatively flat and straight, to prevent unnecessary stress being placed on particular spinal segments. You should make sure that your back has appropriate support from your mattress and pillow and that these are replaced and turned regularly to maintain their optimal shape. Taking care of how you get out of bed in the morning is also important, as keeping you back as straight as possible and avoiding sudden moments will give your back a gentle start to the day.
Just like getting out bed, be mindful when getting in and out of your car, and note that sitting down first and then placing your feet in the car will make it easier to keep you back straight. Before driving make sure that your lower back is properly supported with something like a lumbar roll. Having the mirrors and seat adjusted correctly will avoid twisting or over extending your body and if driving long distances, take regular breaks and do some mild exercise.
As part of the treatment for back injury, exercise will be prescribed by your physiotherapist and should become part of your long term management. This may include a combination of stretches and strengthening exercises which are required to maintain your spinal alignment and prevent you from reverting back to your previous posture and biomechanics.
Clinical pilates or specific gym exercises are a great medium for this, particularly in a supervised environment where your physiotherapist is able to monitor your posture and positioning at all times so that you gain the most benefit.
Hydrotherapy is also a fantastic way to complete your rehabilitation. Due to the waters buoyancy, the weight you have to bear is reduces, as is the impact on the affected areas, with the warm water allowing greater flexibility.
By completing these structured exercise programs by a physiotherapist, the resistance, intensity and difficulty can be regularly monitored and adjusted for individual stages of rehabilitation.
Whist you may be free of back pain, these simple exercises can be used to strengthen and stretch your back. Performed slowly each day they are easily achieved and can be used to boost your back strength for the future.
- lie on back with both knees bent
- tighten buttock muscles
- gently curl tailbone up off bed
Double Knee To Chest
- use both hands to bring both knees to your chest
- do not lift your head
Single Knee To Chest
- use both hands to bend one knee to your chest
- do not lift your head
Please not that if at some point you feel like your back pain is recurring it is important to seek early intervention. Your physiotherapist will be able to analyse your symptoms and resolve your pain much more quickly if you return earlier as the injury can be isolated before effecting other muscles and ligaments.