Sciatica & Back Pain Relief

There are a large number of conditions that can result in back pain. For example, poor posture, car accidents, and sports-related injuries are just a few of the ways that someone may develop back pain.

 Injury is the most common cause of back pain. This can happen in one of two ways: 

1) An instant, sudden trauma, such as a car accident

2) Repetitive use that puts excessive stress on the back over time, such as bending down several times throughout the week to pick up boxes. 

Some other factors that may contribute to your back pain include degenerative disc disease, lumbar spinal stenosis, fractures, herniated disc, osteoarthritis, osteoporosis, and tumors of the spine.

This is why it is important to have a physiotherapist conduct a comprehensive assessment to determine the cause of your back pain. 

Back pain commonly results from a muscle strain or injury; however, it can also develop as a result of an underlying condition, such as a herniated disc, sciatica, or degenerative disc disease. Poor posture, car accidents, and sports-related injuries are also common ways that someone may develop back pain. Your physiotherapist will focus on treating the root of your back pain, in order to help you regain mobility, function, and comfort.

You can treat your back pain with physiotherapy. Physiotherapists can address back pain by helping to improve your range of motion, strengthening the muscles in the affected areas, and using targeted massage to reduce tension. In many situations, working with a physiotherapists  can significantly reduce the severity of your back pain, and may even help you avoid more invasive procedures, such as surgery or injections. 

It is common that the muscles used to support the lower back may become weakened from inactivity. Our physiotherapists will prescribe targeted, easy-to-do exercises that we will walk you through, in order to help your back muscles regain their strength. This will help provide greater support to your spine and reduce any inflammation you may be experiencing. 

While the best exercises for your back pain are relative to your specific conditions, some common ones your physiotherapists may have you do include spine stretches, bridges, and pelvic tilts.

Like all other parts of the body the lower back is comprised of numerous muscle groups, these muscles work to stablize and move the lumbar spine and pelvis. Occasionally the muscles in the lower back become overloaded due to vigorous activity or heavy lifting and repetitive bending movements resulting in a strain. 

A strained or torn muscle in the lower back leads to inflammation and pain at the site of injury. Movements of the lower back which stretch or place stress on the injured muscle are usually painful, and the area is often tender to touch 

The facet joints lie between and behind adjacent vertebrae and allow for bending, twisting and rotational movements of the spine. Under normal circumstances these joints glide smoothly over one another allowing for pain free movement in all available directions. Occasionally when placed under prolonged periods of stress (such as extended periods of sitting with poor posture or falling asleep in an awkward position) or due to sudden overloading of the joint, the joint surfaces can become compressed together leading to inflammation, irritation and reduced joint motion. 

Often it is very hard to diagnose Facet joint Syndrome based on symptoms alone as many of the common symptoms associated with facet joint injury mimic that of other common lower back pain injuries. Typically, patients will complain of localised pain around the injured joint(s); however, occasionally there can be referred pain into the buttocks, thigh, or groin. Pain is often aggravated by certain movements which compress or stress the injured facet joint, typically bending backwards or to the side that is injured. The injured area usually feels stiff, and movement is restricted due to pain.

Facet joint injuries are treated with a combination of hands-on manual therapy and corrective strengthening and stretching exercises to prevent pain reoccurring. Hands on manual therapy usually consists of joint mobilization/manipulations and deep tissue massage techniques to restore normal joint movement and alleviate symptoms of muscle tension. Spinal decompression therapy or traction may also be used to provide gentle and painless separation of jammed facet joints.

Commonly referred to as a “slipped disc”, herniated discs occur when the nucleus of the disc (a soft jelly-like substance in the centre of the disc) starts to push outwards against the disc wall resulting in a protrusion or bulge. In some cases, excessive pressure can lead to a tear in the disc wall and leakage of irritating disc substances onto nearby tissues and nerve roots. This leakage can result in both localised and/or referred pain down the into buttock, leg, and foot. Where the disc herniation is severe it may compress on the nerve root itself causing pain, altered sensation (pins/needles, numbness, burning) and sometimes weakness in the leg. Disc herniation is common in the lower back and neck.

There are several factors which can affect the health of discs and increase the risk of herniation. Mechanically, a stiff spine that doesn’t move well and/or weakness in the surrounding tissues that support the spine, means that other structures including the discs are forced to withstand greater stresses. This places the discs at a higher risk for injury. Other contributory factors to the deterioration of disc health include poor lifestyle choices such as lack of general exercise, prolonged sitting, smoking, poor dietary habits, and obesity. Additionally poor posture, heavy lifting, bending activities, and history of previous injury can increase one’s susceptibility to disc injuries.

The treatment of disc herniation must target both the source and the factors which are contributing to the injury. In mild to moderate cases treatment may involve a combination of joint mobilization and soft tissue massage techniques to help regain pain free movement and the use of correction strengthening and stretching exercises to prevent reoccurrence. In more severe cases of disc herniation spinal decompression therapy/traction may be used to reduce pressure on the injured disc and aid healing.

The term pinched nerve is often used to describe symptoms of nerve pain in the body. Common examples of conditions which are caused by nerve related pain or injury include carpal tunnel syndrome, thoracic outlet syndrome, sciatica, piriformis syndrome. In all these conditions inflammation or tightness/ spasm in the surrounding muscles and connective tissues leads to the nerve becoming compressed and irritated. Compression of peripheral nerve fibres causes pain and altered sensation (such as pins/needles, numbness, weakness) in the areas supplied by the nerve.

Treatment of a pinched nerve is aimed at releasing the structures which are compressing the nerve such as the muscles and connective tissue. In most cases this involves the use of manual therapy techniques, dry needling, and corrective stretches 

The term sciatica is used to describe a set of symptoms which arise from the sciatic nerve being compressed or irritated. There may be several causes of sciatica including.

1. Disc herniation or bulging which is impinging on the sciatic nerve root. 
2. Disc rupture and leaking of the disc substance (annulus propulsis) onto the nerve causing irritation. 
3. Piriformis syndrome
4. Spinal stenosis where there is narrowing of the spinal canal causing      compression of the spinal cord, cauda equine or sciatic nerve roots.

Symptoms of sciatica may include one or all of the following:

-  A sharp burning pain down the leg and into the foot

- Pins and needles

- A loss of sensation or numbness in parts of the leg or foot

- Lower limb weakness and inability to weight bear through the affected limb

Prior to implanting a treatment plan for Sciatica our Registered Physiotherapists will carry out a thorough assessment to ascertain the cause of your sciatica. Once this has been identified the goal of treatment is to reduce pain and correct any abnormalities (such as soft tissue tightness, joint restrictions, core muscle weaknesses, pelvic and/or lower limb misalignments) which would have contributed to development of your pain. This may entail our physiotherapist using any of the following treatment methods: joint mobilization, manipulations, massage, shockwave therapy, laser, myofascial release, heat therapy, core strengthening and mobility exercises, mechanical lumbar traction, acupuncture, and dry needling techniques.

 The sacroiliac joint is located at the back of the pelvis and is a common cause of back pain. It has been reported that as high as 15% of all pain experienced in the lower back region is due to sacroiliac joint (SIJ) dysfunction. SIJ dysfunction refers to abnormal function occurring at the joint, which in turn overloads the structures in and around the joint leading to pain and inflammation. SIJ dysfunction can contribute to or be the sole cause of lower back, buttock, hip and/or groin pain.

SIJ Dysfunction may result from: 

• An acute traumatic accident such landing on the joint from a height. 
• Gradual overload due biomechanical mal-alignments and excessive stress being placed through the joint.
• Hormonal changes which can affect the level of axity or stability in the joint during pregnancy.

Symptoms usually present as a dull ache in the lower back region on one side although pain can present on both sides. Aggravating activities may include bending forward, sitting, transition from sitting to standing, and raising the knee up towards the chest.

Treatment of SIJ related pain must focus on the entire lumbo-pelvic-hip complex addressing any restrictions in joint or soft tissue movement and any muscle imbalances due to weakness. Our Registered Physiotherapists at Central Physiotherapy and Massage are very experienced in managing lower back and SIJ pain and may use a combination of joint mobilization techniques, shockwave therapy, laser, strengthening and stretching exercises, myofascial release techniques, dry needling, to address causative factors.

 Lower back pain affects up to 80% of people at some stage in their lifetime and is the most common cause of disability in North America. There are numerous structures in the lower back which can cause pain if injured. One common source of lower back pain are the intervertebral discs. These discs are rounded structures which lie between our spinal vertebrae to provide mobility, cushion, and shock absorption to the spine. 

In total there are 23 discs in the human spine which are made up of an outer fibrous ring of connective tissue, the annulus fibrosis, and a soft inner jelly like substance the nucleus pulposis. The discs absorb a large amount of force with our daily activities of living, for example in unsupported sitting pressures exerted on the discs in the lower back are one third greater than in standing, if we compound this with the number of hours, we sit in front of the computer in the office it’s not hard to see why disc related lower back pain is so common.

Disc related lower back pain can result from a single incident whereby the disc is overloaded to the point of failure or may be more degenerative in nature and occur do to wear and tear overtime. The severity of symptoms will depend on the extent to which the disc has been damaged or comprised. Usually with an inflamed or bulging disc there will be debilitating pain across the area of the lower back which may radiate down into either buttock or thigh. In the most severe cases where there is a complete prolapsed or a leaking disc that is compressing the nerve root itself there may be radiating pain down the leg as far as the foot, pins and needles, loss of sensation and/or strength.

Our Registered Physiotherapists are experts in the management of lower back pain and disc related disorders. To determine the source and underlying causes of pain a detailed assessment of the back, pelvis, hips and lower limb. We will work hard to help you restore pain free movement and function in your lower back. Two of the major causes of disc related pain are poor flexibility of the lumbar spine and hips, and poor core strength in the muscles that stabilize the spine and pelvis.

To provide pain relief and restore pain free function our physiotherapists may use a combination of some of the following treatments: spinal mobilization, lumbar traction, massage, heat, dry needling, shockwave therapy, laser, lumbar brace/support, strengthening and therapeutic exercises. In severe cases of disc injury orthopaedic intervention may be warranted. Central physiotherapy has links with Central Alberta’s leading back specialists and our physiotherapists will be able to refer you on for further review with an orthopaedic specialist if required.

Ankylosing Spondylitis (AS) is a chronic inflammatory condition which mainly affects the lumbar spine, sacroiliac joint and the pelvis. Symptoms usually present gradually with those suffering from the condition complaining of a dull chronic ache in the lower back and gluteal region and accompanying stiffness which is particularly bad in the morning time.

The exact cause of AS is unknown. But researchers think that genetics play a role. A gene called HLA-B27 is found in most white Americans who have AS. But this gene is found in only 50% of African Americans who have AS. There are also some people with the HLA-B27 gene that don't develop AS. Less than 5% of people with the HLA-B27 gene have AS.

AS is more common among people ages 17 to 35. It can happen in children and older adults, as well. The disease affects more young men than women. It tends to run in families

Physiotherapy treatment consists of manual therapy techniques and mobilisation of the lumbar spine and sacroiliac joint to help reduce stiffness and pain. Exercise protocols can also be introduced to improve mobility and build strength in the muscles that support the lower back and pelvis. Various massage techniques are sometimes employed by massage therapists to manage pain and reduce muscle tension in the affected areas.