Mechanical Back Pain is the most common type of musculoskeletal pain effecting 80% of the population at some point in their life span. “Mechanical” back pain refers to pain that is stimulated by movement or is caused by tissue stress during an activity. Characteristically certain movements reproduce this type of pain and other movements consequently reduce the same pain. Mechanical back pain is differentiated from medical type pain which is due to an ongoing disease process. Pain of this type commonly presents as unyielding pain which increases as the disease process progresses. It is important to note the difference because Physical Therapy attempts to address only the mechanical type pain and, if a given condition is determined to be the later, then referral to your physician is necessary.
Mechanical back pain is the result of an inflammatory process (chemical mediated) generated by tissue strain in the spinal column. From which of the numerous tissues in the spine is responsible for the pain is difficult to determine. There are diagnostic tools, both medically speaking and physically performed, which attempt to isolate and identify the causative structure. An MRI (Magnetic Resonance Image) exam is the gold standard for identifying soft tissue damage in the spine for the purpose of diagnosing pathology. Physical Therapy evaluation may identify the spinal level or levels involved by detecting motion restriction or lack of motion control in the spinal column for the purpose of diagnosing motion impairment. Injury to a spinal level stimulates a cascade of events that lead to change in the connective tissues of the spine. Mechanical failure of tissue may involve sprain of the spinal ligaments or capsules, herniation or fracture of the intervertebral discs, internal impingement of articular cartilage in the facet, tearing of fascia or myofascial tissue, fracture of bony elements or entrapment of vascular or neural structures in the canal spaces of the spine. Injury to these or other tissues in the spine result in an acute inflammation process that may initiate and prolong the painful condition.
Generally, the tissues of the spine go through mechanical change resulting in dehydration and degeneration. There are several medical diagnoses which describe and correlate with the stage and severity of degeneration of the spine. These diagnoses are formed based primarily on radiographic information. Common diagnoses include:
Disc Protrusion – minor bulging of the disc material
Disc Herniation – major bulging of the disc material due to failure of the annulus
Spondylitis – inflammation of a spinal joint causing pain and stiffness
Spondylosis – stiffening of the vertebral segments resulting in narrowing of the spinal canals and spaces
Spondylolisthesis – mal-alignment of the spine due to loss of ligamentous integrity resulting in anterior sliding of a superior vertebral body and possible nerve compression
Facet Arthopathy – changes in the joint surface cartilage due to continuous compression
Degenerative Joint Disease – obliteration of the normal joint space
Degenerative Disc Disease – loss of disc hydration and height resulting in vertebral compression and bony spurring
Spinal Osteoarthritis – end result of degeneration in the spine involving multiple connective tissues and poor tissue quality.
Whatever the level of involvement of tissue injury, Physical Therapy attempts to restore normal mechanical motion through the spinal segment or segments affected. This might be accomplished through manual therapy by implementing segmental mobilization techniques or through active exercise for restoring range of motion, tissue flexibility, motor control, strength and endurance. Typically a treatment plan of localized manual therapy, motor re-education, modalities, prescribed exercise and a home-maintenance program results in functional improvements of 60 to 80% within six weeks of initiation of treatment.
Follow these guidelines for assistance in recovery from spinal pain.
Tips for acute type spine pain (within the first two weeks of onset):
- Whenever possible, rest in a non-weight bearing position such as supine recumbent with your legs elevated. This relaxes the spine in neutral and approximates the nervous system.
- Use anti-inflammatory measures such as ice for a duration of not longer than 20 minutes to the local region is recommended.
- The use of Non-Steroidal Anti-inflammatory agents such as Advil, Aleve or Motrin is appropriate provided that you are medically cleared by your physician to be taking them.
- Temporarily immobilize the area by wearing a soft brace or wrap/tape to assist with swelling reduction and muscle relaxation.
- Begin non-weight bearing range of motion drills which alternate the spinal position from flexion to extension as soon as possible. Examples of this are "hands and knees rocking" and "supine trunk rotation".
- Consciously reduce the amount of combined weight bearing spinal rotation and spinal flexion when transitioning from one position to the next (i.e. getting out of the car or out of bed).
- Restrict your overall work strain by limiting your work time to 30 minutes and limiting your work load by managing your center of gravity through avoidance of lifting, reaching, pushing or pulling.
Tips for chronic type spine pain (existing for several months):
- It’s time to start moving as it is critical to increase blood flow to the area for the purpose of delivering oxygen and other metabolites important in the repair process.
- Use of low level heat for a duration of 15 to 20 minutes can assist in the flow of blood to the area. Use caution so as not to burn the epidermis.
- Use of non-narcotic pain killers such as Tylenol is appropriate provided that you are medically cleared by your physician to be taking them.
- Low level cardiovascular exercise such as walking or cycling for a duration of 20 to 30 minutes can also assist in profusion of blood through the core to the extremities.
- It is important to re-establish complete range of motion of the spine and therefore attempt to increase total range during motion drills.
- Start anterior spine muscle control exercises by practicing isometric contractions in a non-weight bearing position. This can be done during active "chin tucks" or the "abdominal draw-in technique".
- It is important to advance your exercises from the isometric types, which develop stability, to the isotonic types which promote movement control during functional tasks.
When should I see a Physical Therapist for my back pain?
Consider seeing a Physical Therapist who specializes in spine care when you notice difficulty moving due to generation of pain or stiffness in a localized area. If you are experiencing functional limitation like limited walking or sitting time, a skilled Physical Therapist can determine the nature of the problem, through examination, without a physician referral. Call (805) 682-1481 for a consultation with a spine specialist.
When should I see a Physician for my back pain?
If you notice that pain and swelling are rapidly increasing and nothing seems to help relieve them, particularly if you have taken time to rest, then it is important to complete a current medical exam with your physician.
