Nonspecific Low Back Pain

Most people will experience back pain at some point in their lives, unfortunately.  Odds are that if you don’t have back pain, you know at least one person who does.  Different studies estimate that between 60% and 80% of people will experience back pain.  It can range from a nuisance to debilitating.

Oftentimes, patients with low back pain ask about getting an imaging study of their spine, such as an X-ray or MRI, to help determine the cause of their pain.  Oftentimes, degenerative disc disease will be seen on imaging reports – particularly if the patient is 40 years old or older.  Disc bulges or herniation’s are another common finding, which can make patients quite anxious and worried. 

As it turns out, these findings are actually quite common – even for someone who has no back pain at all!  Let me say that again:  These are things we can see on a spine of someone who is not in pain!  On the other hand, sometimes a patient in terrible pain can have a perfect looking X-ray or MRI!  So, what on earth does this mean? It means that there is something else that is causing the pain.  We refer to this as nonspecific low back pain.

That is sometimes why you hear stories of friends and family who have had back surgery that failed.  The surgeon, in a good faith effort, eliminated what looked iffy on the MRI, but it didn’t help!  That’s because the bulging, degenerated disc wasn’t the problem, and why many doctors are reluctant to order MRI’s.  Not only are MRI’s expensive, but they can lead us down the wrong path – away from the path of recovery and down a path of injections and surgery instead.

What studies show (and what we at PDR see everyday) is that muscles and soft tissue are the root of many problems, which don’t even show up on imaging studies.  If you have tight muscles, weak muscles or imbalanced muscles, that can create a lot of strain on the spine.  And that strain can hurt a lot!  Sometimes that pain will even refer down into your buttock or thigh (oftentimes referred to as sciatica), which can seem even scarier. 

Muscular problems can happen to anyone.  An athlete can sprain a muscle, an otherwise healthy person can slip on the ice and irritate a muscle, a worker can strain their back by using poor body mechanics and/or sit with poor posture all day at work.  The wonderful news is that these problems are very manageable!

At PDR, our physicians, physical therapists and occupational therapists are highly skilled at helping you get your spine back into shape.  We are experts at knowing which stretches, strengthening exercises and manual therapies to use to get you back on track.  So try not to worry if your imaging studies show a problem, we can help

What is Workability and Why Does it Matter?

Workability is the practical capacity to succeed at something, more specifically, pertaining to a job in a workplace.  It is important from many aspects to understand just what a practical capacity is, and how it can or cannot be achievable on a daily basis.  Within the physical therapy realm, workability can be assessed and treated with a realistic approach to determine the feasibility and safety of a job or a certain aspect of a job and how it relates to a specific person.  This is obviously important because when done with correct body mechanics and muscle recruitment, most any job can be made a safe job within reason, and ultimately prevents injury and or disorders from occurring.  Incorporating proper body mechanics with methodical and realistic lifting capacities is important and effective.  

From an employer’s perspective it would be in their best interest for their employees, as well as for them to avoid work injury and compensatory reimbursement costs due to said injuries.  All too often, people experience injury due to unreasonable expectations of certain aspects of jobs, or some jobs as a whole.  When an injury occurs, many times there are temporary restrictions put on the employee by a doctor or therapist to ensure the patient re-enters the job in a safe and confident manner.  In certain cases, when the workability is determined unsafe or unrealistic for the patient/employee to return to, jobs can be modified permanently if the employer chooses so.

Physical and Occupational therapists are some of the primary professionals that are involved when workability needs to be assessed, whether restrictions need to be applied, and for how long.  With the primary goal of restoring function prior to injury, focused strength at the site of injury, as well as surrounding supportive muscles is vital to the initial success of, and the future sustainment of the recovery  With proper education to the patient, along with skilled focus on strength and injury prevention, physical therapy can be very effective in not only returning person to prior workability function.  This also prepares them to take necessary measures to prevent and reduce risk of injury as before.

The Neck and Back Pain Cycle

Neck and back pain is a result of many types of injuries and potential causes, including motor vehicle accidents, lifting injuries, pregnancy, arthritis, disc, and joint disorders to name a few.  The initial cause of the pain routinely leads to a “diagnosis” but what is not often times explained is the pain cycle that all of these causes and diagnosis create, and more importantly how to break the cycle of pain.

Regardless of the initial cause or diagnosis, most neck and back injuries will enter a familiar cascade of secondary effects from pain, which is referred to as “the pain cycle”.  Pain in the body, especially pain lasting more than a few days or weeks can create secondary effects to the musculoskeletal system which leads into more pain.

Pain creates decreased activity and movement, as the body’s natural response is to guard the injured area, providing rest and healing.  However, after the first 24-48 hours of an injury, this lack of motion can start creating more problems than good.  If prolonged lack of activity ensues, the more secondary weakness and range of motion loss can be expected.

  • Pain guarding, spasm, and lack of normal muscle activity of damaged structures leads to weakness and muscle inhibition.

Weakness can stem from lack of physical activity, but additionally (and more likely) is from muscle inhibition.  The nervous system becomes alarmed during the pain cycle, and actually sends less signals to the affected muscle area.  Lack of the ability for muscles to normally contract and relax is called muscle inhibition.  In low back pain, the multifidus (low back), lower abdominals, and other support muscles have been shown to be inhibited.  A study found that a lack of strength of the support muscles by 10% can actually increase strain to the joints and ligaments by 65%.  So you can see, weakness of the support muscles will lead to more pain. 

  • Muscle inhibition leads to faulty movement patterns, compensation, muscle imbalances, and weakness of postural support muscles.

Tissue changes now occur within the affected muscle areas, and sometimes even include muscles away from the injury site, due to compensation.  It almost seems that what started as a local pain has now spread.  Some muscles tighten and shorten, as scar tissue develops.  Others weaken and shrink, or atrophy.

  • Adaptive shortening of tight muscles and atrophy of weakened muscles occurs over time.  Postural pain develops or increases.

Lack of range of motion, tightness, and poor movement patterns seem almost permanent.  More pain, and now inability to bend, lift, turn the head or trunk, and other daily functions are impaired.

  • Myofascial adhesions (scar tissue) envelopes once normal muscle tissue, and creates lack of range of motion, tightness, pain, and loss of function.