Spinal Pain

Specialist care of back pain, neck pain and nerve problems

Physiotherapy for Spinal Pain

Neck and back pain are the things we treat most commonly. Most people suffer back and neck pain at some stage in their life – nearly 85% of the population. Some neck and back pains resolve quickly and naturally and don’t cause too much of a problem – you shouldn’t worry about it at all if that’s the case. It’s not a sign of any major problem or concern – just go back to your normal life and forget all about it.

We are here if the symptoms don’t settle naturally. Research shows that if pain persists or is severe, you will do better if you seek care within the first 6 weeks.

People who seek care for their back pain between 2 and 4 weeks of onset have a much better chance of avoiding long-term problems, and people who seek care before the 6-week mark improve faster with less input than those who wait longer.

Back Pain

Back pain can come from lots of different structures and sources. We assess back pain in the same way in which we assess all problems – attempting to understand not only the type and source of pain but also the contributing factors to its development.

This approach is at variance with many established guidelines on back pain that eschew diagnosis in back pain, saying that it is impossible (Koes et al 2010). Some even feel that diagnosis causes more harm than good (Dagenais et al 2010).

You might have felt this in practice – being given “standard” back care or “standard” back strengthening exercises or being told that treatment is unnecessary or ineffective.

Our Approach is Different; Pragmatic and Better

Our approach is based on new research that shows that specifically tailoring intervention to diagnosis gives better outcomes.

The Specific Treatment for Problems of the Spine (STOPS) trial showed, for the first time, moderate to large effects for specific Physiotherapy, comparing it to the care suggested by many guidelines (Ford 2016).

The STOPS trial was run in Melbourne and was the brainchild of Jon Ford, a colleague of Clinical Director Howard Turner from LaTrobe University, where they trained together.

Our assessment model applies to back and neck pain, too. Assessing fully allows us to tailor treatment more accurately and more effectively.

There should be no “standard treatment” for back and neck pain – it should be individualised to your specific presentation and clinical findings

The STOPS trial classifications

The STOPS trial proved that treatment tailored specifically to your back pain presentation is effective, and more effective than normal, guideline-based treatment. Assessment of these classifications requires substantial training and takes skill, precision and practice. This is a specialist area.

The STOPS trial specified 5 subclassifications for back pain. We add one more – Sacroiliac Joint (SIJ) Pain. Whilst SIJ pain can’t cause back pain, it can cause buttock and leg pain that mimics other sources of pain

Find out about Sacroiliac Joint (SIJ) Pain

Radiculopathy

Presents with mainly leg pain and sensation changes or weakness are found on neurological examination. May also be positive on neurodynamic testing, such as the Straight Leg Raise.

Reducible Discogenic Pain

Presents with back and leg pain that is worse in the morning and when you bend forward or get from sitting to standing. Coughing or sneezing also often hurts. It improves on examination with one direction of movement or sustained position.

Non-reducible Discogenic Pain

This produces the same symptoms as Reducible Discogenic Pain but on examination there is no improvement with any particular direction of movement or position.

Zygapophyseal Joint Dysfunction

Presents with unilateral back pain +/- leg pain that usually gets worse on bending backwards and to the painful side. Examined through a palpation assessment of the spine.

Multifactorial Persistant Pain

None of the other classifications apply and a high score on a particular screening tool

It is very common for people to have signs of more than one pattern, and important that all components be dealt with during treatment.

Other Research and Writings

There is, of course, lots of research and opinion on back pain. We keep up to date and incorporate these ideas into our practice as they are proven to be helpful.

Warning

In rare cases it is important that you have your back assessed immediately.

The following warning signs indicate the possibility of Cauda Equina Syndrome, that can lead to permanent damage.

IF YOU ARE EXPERIENCING ANY OF THE FOLLOWING SYMPTOMS YOU SHOULD SEEK IMMEDIATE MEDICAL ATTENTION:

Loss of feeling or pins and needles between your inner thighs, genitals, back passage or buttocks

Altered or loss of feeling when using toilet paper to wipe yourself, or during sexual intercourse

Loss of feeling, loss of control or increasing difficulty when attempting to urinate or pass a bowel movement, or when you stop or control your flow of urine or bowel movement

Not knowing when your bladder is full or empty

Change in ability to achieve an erection or ejaculate

Neck Pain

Neck pain can present in many different ways and the subclassification of neck disorders follows a similar structure to the classification of back pain above.

Neck pain can, most obviously, be felt in the neck with pain and restricted movement, but also can be felt in the upper back, down the arm or in the head. The upper neck is a very common source of headaches and can be a trigger for migraine.

If you have Headache or Arm Pain, Get Your Neck Assessed

Neck problems often refer pain down the arm. Sometimes there is nothing or very little to feel in the neck itself but you might have shoulder pain, elbow pain or hand and wrist pain. In this way a neck problem can be misdiagnosed as a shoulder problem, or an elbow problem such as a “tennis elbow” or hand tendon issue.

If you have arm symptoms and your neck hasn’t been assessed properly(*), come and see us.

(*) By properly, we mean a combination of movement and palpation assessment, a neurological assessment and tests called neurodynamic tests.

Finally, A Word About X-Rays and Scans

Xrays, scans and nerve conduction studies are done frequently in the investigation of back and neck pain and often provide really useful information. MRI’s in particular provide extraordinary detail of a person’s anatomy and sometimes they really help in diagnosis because the findings directly relate to their complaint. Unfortunately – and here is the problem – the findings more often DON’T relate to the problem.

It is perfectly normal to have signs of wear and tear and even some of the things you have been told are sometimes a problem, like disc prolapses, are also very common and very normal. In backs, for example, 91% of PAIN-FREE people show disc degeneration and 32% have disc protrusions. Likewise, osteoarthritis (OA) of the hip found on X-Ray has no relationship to hip pain unless you are in the very small minority with severe OA.

The point is: don’t be disheartened if these things are found on your scan / MRI / X-Ray – more often than not they are normal findings and they have to be related to your complaint to be relevant. Come discuss the findings with us.