My back hurts. Why is that?
Back pain is one of the common ailments suffered today. In fact, almost 20% of the entire Singapore population suffers from back and neck pain at any one point in time.
Despite it being such a common ailment, determining the exact cause of back pain is often difficult. By breaking down back pain into stages, Physiotherapy treatment and Core Stability training can help alleviate pain and work towards preventing recurring back pain over the long term. Today, conservative treatment is able to resolve some 95% of back pain cases when attended to at the right time. Only 5% of patients really need surgery.
Complex interplay of structures
Your back is a complex supporting assembly, made up of a set of interacting structures such as joints, discs, ligaments, nerves, vertebrae and muscles. Pain is rarely a result of just one of these structures failing. More often than not, it is a combination of physiological and environmental conditions. Unless you address these conditions, you can expect recurring back pain.
This makes treating back pain a challenging problem. The cause of back pain is normally multi-faceted, requiring a multi-pronged treatment approach. It is therefore necessary to accurately assess and treat the underlying cause and contributing factors in stages. Before we look at the different stages, it is important to understand first why your back hurts.
Why does your back hurt?
A common direct cause of back pain is the stress we place on our spine. To get an idea of the amount of pain that stress can cause, bend your index finger as far as it can go, away from the palm of the hand and hold it there. How does it feel? Now think about how the same happens to your spine when you sit slouched for long periods at a time, bend over to pick something up or play sports, like golf.
The repeated and prolonged stress that is placed back affects our spine structures in a whole lot of different ways. It may cause our discs to bulge, our ligaments to over-stretch, muscles to strain and joints to wear down a lot quicker.
Your spine is capable of a great deal of movement. However, to keep that mobility and freedom, all of the structures must work together smoothly and efficiently, like a ‘well-oiled machine’. Pain arises when one of these parts fails, such as when a bulging disc, bony spur or inflamed ligament irritates or traps a nerve.
Good Back Health
In order to have good back health, the spine needs to be mobile in all its segments, not stiff or excessively loose. The muscles around the spine, hips and legs should be strong, flexible and balanced. Whenever there is poor alignment, weakness, tightness or imbalance in these areas, the spine is vulnerable to injury. This instability, better known as “core instability” often predisposes to back pain.
Poor core stability amongst low back pain sufferers
Studies have found that sufferers of chronic low back pain have delayed contraction of the deep abdominal muscles with movement. Subjects in the study without back pain were able to activate the core muscles first, in anticipation of movement, showing that deep abdominal muscles or core muscles served to stabilise the spine.
The activation of the core muscles is effective in relieving back pain and preventing recurrences by providing the necessary support. Exercises that improve the strength and control of these deep core muscles are known as core stability exercises.
Three stages back pain
There are 3 different stages to back pain – acute, sub-acute and chronic. It is important that you seek the appropriate treatment for each stage.
Acute stage (The first few days)
In the first few days of a back pain episode, the main objective is to relieve pain and inflammation. Physiotherapists perform gentle hands-on techniques and teach the patient pain-relieving postures and exercises that reduce pressure on the painful structures. They may sometimes use Traction to relieve nerve compression. To release a locked segment of the spine, it is important to note that only some physiotherapists trained in manipulation are able to do so safely.
Physiotherapists also relieve pain and inflammation using special machines such as shortwave treatment (deep heat), interferential therapy (involving cross electric currents), ultrasound (using ultrasonic waves to promote healing) and TENS (Transcutaneous Electrical Nerve Stimulation – electric stimulation that blocks pain impulses to the brain).
Sub-acute stage (from 3 days to 3 months)
When the pain and inflammation have subsided, this is the time to mobilise stiff spinal joints, restore correct alignment, stretch tight muscles, strengthen weak muscles and start on a core stability programme. The goal at this sub-acute stage is to restore a flexible and balanced, yet strong and stable spine. If imbalance and weakness remains, the pain will take longer to resolve and chances of injury reoccurring are very high. It is important to address contributing factors such as flat feet, poor ergonomics or sporting technique.
Chronic stage (more than 3 months)
When the pain has lasted so long, there are usually mal-alignments and biomechanical factors that have not been properly addressed. The spine or pelvis may be out of alignment or causative factors may still be present, for example working on a laptop for long hours. Pain-sensitive scar tissue will have built up over time because of the repeated injury and this will need to be broken down by deep tissue massage. The core muscles, which act like a natural corset, are likely to be switched off and will need to be re-activated through core stability training.