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COMMON INFORMATION

LOWER BACK PAIN

NECK PAIN

Common conditions.

 

What is a Disc?

 

Your back is made up of 32 bones called Vertebrae.  In between each bone is a  fibrous disc like structure. This disc acts as a spacer and helps to maintain the correct distance between the vertebral segments. It imbibes water at night and therefore acts as a shock absorber during the day. In young people the center of the disc is softer and more gel like. As aging occurs this gel like substance becomes  fibrous. The fibrous layers of the disc  are able to be torn from consistent pressure or from a sudden force. The discs in the lumbar spine do not respond well to repeated bending and/ or twisting. Sudden vertical force or bending / twisting force can cause a tear in the disc. This results in swelling  of the tissues that surround the disc and can cause pressure on an adjacent nerve root. Sometimes the disc  tear and herniated material is large enough to also cause pressure on the nerve root as it leaves the spinal cord or on the spinal cord itself.

There are clinical tests that your  Physiotherapist at The Back Clinic can use to assess the likelihood of a disc tear and/or nerve pressure.  We have a good working relation ship with the Orthopedic specialists and can refer you for further advice and investigation if required.

Do disc tears get better?

   

Although the fibrous material is slow to heal it does get better, healing with scar tissue. This takes some time, often upwards of 18 months. During this time it is important not to continue to place pressure on the disc by performing tasks that increase intra discal pressure; e.g. we know that double straight leg raises, often given as an abdominal exercise in the gym, increase the pressure on the disc almost to its maximum extent.{ Low Back Disorders, Mc Gill (2002)} These therefore should not be performed as part of a rehabilitation regime.

However we also know that it is very  important to resume as normal activity as possible in the weeks and months after a disc tear. This should include work and recreation. The spine motion helps promote healing.  However it is useful to know how to modify or change the motion required to allow pain free activity. This is what you will learn at The Back Clinic.

Why does the Doctor tell me it’s my back when my leg hurts?

 

On examining your leg and your back, your  Dr., or your Physiotherapist may tell you that your leg pain is coming  from your back. This deduction is reached from a series of tests which help to establish the origin of pain. Pain which is sited away from it’s originating site is called referred  pain It may be mild to severe. The level of the injury to the spine  can often be determined by the pain pattern. However what structure in the spine is causing the pain is not so easily determined. 
 

Your Physiotherapist at The Back Clinic has the skill to determine the likely origin and cause for the pain, explain it to you, and treat you to relieve your symptoms.

My pain feels like a pinched nerve - is it?

   

Pain, even severe pain is not a good indicator of a pinched nerve. Pain from a nerve being pinched or squashed is usually a burning pain and is usually because pressure on it has caused a loss of blood supply to the nerve. Pressure on a nerve may also be felt as numbness. Pins and needles or altered sensation are also indications that there is some nerve involvement but not necessarily  pressure on the nerve. Weakness, in the arm (with neck pain), or in the leg associated with changes in sensation may indicate a pinched nerve.

Your Physiotherapist can help determine  whether you have pressure on a nerve and give you advice. Your Physiotherapist has skills to treat some forms of nerve discomfort and can determine whether onward referral for neurological or orthopedic examination is appropriate.

 

I can’t sleep at night because of pain. What should I do?

 

You should see your Doctor or your Physiotherapist as soon as possible.  Being woken by pain at night by pain that you then can’t relieve by change of position or medication may be an indicator of a serious condition. However most often back pain at night occurs when stiffness sets in, resulting in pain as you change position. Physiotherapy treatment and medication can usually ease your symptoms. It is important to have treatment because  consistent lack of sleep makes you more prone to injury and more sensitive to pain.

 

A health professional said I have to learn to live with my back pain. Is there anything that can be done?

The way we use our bodies can be inadvertently “feeding” painful symptoms. At The Back Clinic we teach you optimal movement strategies to minimize  strain of your neck and back.
Research has shown that exercises to strengthen arthritic joints is beneficial  for improving function and reducing pain.

Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews 2008

Do I have to go to my doctor to get an appointment at The Back Clinic?

You may attend any Physiotherapy clinic with or without a referral from another Health Provider. Call us for a comprehensive assessment of your symptoms. (07) 839 1166


I’ve had Physiotherapy. What makes you any different to others?

At The Back Clinic we take the time to listen and understand your pain with an hour-long first appointment. This allows us to formulate an effective treatment programme and have time to educate you about your body.

We focus on retraining your movement patterns to reduce strain on your neck and back. This retraining is task focused so you can integrate  your new patterns into your everyday life. This targets the cause of pain that seems to come often, remain for long periods and is difficult to understand. This pain is often termed in the medical world as  ‘non specific’ which means it is more about how we move or the postures we adopt, than the structure we are straining. However where a specific pathology is identified your Physiotherapist is able to direct you in the best management of this with suitable pain relieving treatment and strengthening exercises.

 

Is my back/neck pain covered by ACC?
ACC will cover an injury to your body if it involves an accident in which an external force was involved, gravity or a twisting force. You will need to provide   your Physiotherapist  with a specific incident, time and date for  us to lodge a claim with ACC on your behalf.  ACC only cover a portion of your treatment costs and therefore a co-payment is required. Contact our office to enquire about co payment fees.
If you injured yourself over one year ago, your Physiotherapist must complete a specific application to ACC for treatment, even if you have had treatment by another Provider. In this instance there is no guarantee that ACC will cover the costs of your visit.

Is Fibromyalgia something you can treat?

Yes, There are several aspects to effective treatment for fibromyalgia. We use movement pattern retraining to reduce strain,  pain relieving strategies such as myofascial release techniques and or acupuncture  to allow movement to occur more easily, strengthening exercise where needed, and education and graded motor imagery to assist when there is a generalized increased sensitivity to pain.

 

Someone said pain is all in my head - is it?

In a nutshell – yes... but in order to understand this, you need to know that pain is constructed in the brain from a variety of incoming messages and can be modified by other nerve messages. This is a wonderful system that allows us to cope and to  heal. Pain is an important and useful output that our nervous system produces as a response to threat.ie you burn your finger ; the threat is tissue damage from chemical and thermal means, the response is pain that makes  you pull your finger away.) It is  dependent on context ( ie; what is going on at the time), emotion, age,  memory, other health systems in the body and perceived threat. E.g.; a violinist who has a paper cut on  her finger just before  a major performance, is likely to experience more pain than a builder with the same paper cut. In the case of the burned finger, the context might be that you burn your finger as you are getting your beautifully cooked cake out of the oven. You don’t want to drop it, so you override the pain and move quickly to put it down. This is also an example of how pain can be modified by the drug cabinet in our brains. Another example  is  the athlete with a sprained ankle who wants to finish the game that they are winning. ( adrenaline and endorphin release can override the immediate pain response).  In each of these cases there is tissue damage causing  an appropriate tissue response in the form of chemical, thermal and mechanical signals that travel faster than a bullet to your brain. It is there that the messages become quantified, so that an action appropriate to the situation can take place. In the case of continual and long term or chronic pain there are chemical changes in the brain that can make incoming signals magnified. This is best treated by education and enabling you to release the powerful  pain medications created by your own body.

  • Useful books to read on this subject are
     
  • Painful Yarns by David Butler and Lorimer Moseley
     
  • Explain Pain by David Butler and Lorimer Moseley
     
  • The Brain That Changes Itself by Norman Doige.


Graded motor imagery is a therapy programme that has been shown to be effective in managing chronic pain symptoms.
 

Can you order X rays?

Yes we can order X -Rays if it is appropriate. X–rays, however, are not always helpful and it is good to avoid unnecessary radiation exposure. Sometimes structural changes are seen on X-ray that look bad, but are normal for age or occupation and may not necessarily be related to your pain. Although these can be alarming to you, it is important to remember that we treat the whole person not the X-ray. Your Physiotherapist can explain your x-rays to you.

 

Lower Back Pain

 

Do I need treatment or will it go away by itself?

 

Most minor back sprains tend to resolve within 2-3 days. I f pain lasts  longer than this and is interfering with you normal activity, then you should seek professional advice. If your back pain is occurring frequently for little provocation then it would also be prudent to seek professional advice. We recommend you see a Physiotherapist in both these instances.

 

 

When do I need to go to the Doctor for my back pain?

 

These three things associated with back or leg pain mean you should seek help at your nearest Emergency Medical Centre or hospital;
1. Numbness or pins and needles in your genital area
2. Inability to pass urine when you want to.
3. Bladder or bowel incontinence.

You should go to the doctor if your pain is constant, unchanging with movement and worse at night.

 

Do I have to go to my Doctor or can I come straight to Physiotherapy?

 

You do not need referral to go to Physiotherapy and can go straight to your local therapist. 

 

 

Is my back pain covered by ACC?

 

ACC is available when an injury has occurred. An ACC  claim can be organized  at THE BACK CLINIC. The definition of an injury is an external force applied to the body or body part and can include gravity and/or a twisting force. ACC does not cover full costs and a co- payment  is required.

 

 

I have leg pain and sometimes numbness. Could this be coming from my back and is this serious?

 

Yes it symptoms coming from your back can include referred pain to one or both legs, and can include numbness and pins and needles. Occasionally this can be indicative of a serious  problem.

You do need a Doctor, Physiotherapist, Osteopath or Chiropractor  to diagnose pain referred to your legs from your back. We can help as we are qualified Physiotherapists. 

 

 

I have low back pain and pain in both legs, can physiotherapy help?

 

Yes we can help first with diagnosis, secondly with appropriate treatment.

 

 

My back only hurts when I’m sitting at work. Should I have treatment?

 

You should not stop work but consulting with a Physiotherapist will help you resolve your symptoms by teaching you appropriate postures, exercises to strengthen muscle groups, appropriate stretches for continued self management  and may facilitate healing with hands on treatment.

 

 

I can’t sleep at night because of my back pain. What should I do?

 

You should see  your Doctor or a registered Physiotherapist, Osteopath or Chiropractor to diagnose the problem. Pain at rest is often an indicator of inflammation and therefore appropriate management is required. This includes medication;  therefore see your GP. Night pain can also be generated by what you are doing during the day and may include stiffness in the mornings. Physiotherapy is able to help with  hands on mobilization also teaching you what about the cause of  your symptoms and how to resolve them. 

 

 
   

Neck Pain

 

How can I get relief for neck pain?

 

We can help! We assess our neck carefully and can use a variety of treatments that have god evidence for effectiveness. These may include  hands on treatment with joint mobilization, soft tissue release techniques, acupuncture , particular exercises for  self treatment and education on posture . 

 

 

I think my headache is coming  from my neck, can this happen?

 

Yes. There are many types of headaches but ones accompanied by a sore neck may be helped by Physiotherapy. We commonly treat neck generated headaches with good success. Treatment is designed to be most appropriate for your needs. We can help you understand whether you have a neck generated headache  or not and will refer you on  to your Doctor if you require medical help. We can order x rays.

 

 

I have pain in my arm and am not sure whether it is from my shoulder or my neck. Can you help?

 

Yes. We are able  to diagnose and treat pain whether it originates in your neck and or your shoulder.

 

 

I have numbness and tingling  in both hands can you help me?

 

Yes. With careful assessment a diagnosis is able to be made as to the likely origin of the numbness. You may need to be referred on to your GP or a Specialist.

 

 

I get sharp pains in my head. Could they be from my neck?

 

Sharp pain can be from the joints in your neck or from other causes. We can help with diagnosis and treatment. You may be  referred on to your  Doctor for further investigation if required. We can order x-rays.