Low back pain?

Our virtual physios can help!

Back pain is one of the most common chronic conditions in Canada. In fact, statistics show that 4 out of 5 adults will have at least one occurrence of back pain at some point in their lives. 

Low back pain is definitely a common complaint we see in clinic, prior to going virtual.

If you Google low back pain, your search results will take you from The Top 10 Exercises for Back Pain to electrical pain modulating units to medications and creams.  

But is all low back pain the same? 

The truth is, some of those exercises you find online may help. Some may make you feel worse. And some may not seem to do anything at all.

For some people, Dr. Ho TENS machines feel amazing, and for others, they are temporary relief if any relief at all. For some people, using a hot pack and maybe a topical analgesic (e.g. A535), and resting for a day or two, is enough.

The fact that not everything works for everyone is a clue that not all low back pain is the same.

What kinds of low back pain are there?

Pain severity and duration can be:

• Acute

Acute refers to symptom duration of six weeks or less. Pan can be sharp or dull, and it can often be severe in intensity. There may be pain shooting into the buttocks and/or into the leg. Range of motion is usually limited and there may be muscle spasm, making daily activities difficult. The pain may affect your sleep quality, as well as your ability to go to work. 

• Chronic 

Chronic refers to symptoms lasting longer than 3 months. Pain is usually deep, aching, dull, or burning. It can be in in the low back and/or travel into the legs. It is often triggered by prolonged positioning (e.g. prolonged sitting) or repetitive movements (e.g. bending forward). Similar to acute pain, chronic pain can affect daily tasks, recreational activities, and ability to work. Because of its prolonged presence, it can cause emotional stress and even depression.

Type of pain can be:

• Sharp, stabbing, sudden
• Dull ache, soreness
• Located in a very specific area or feel very general and vague
• It can be on one side of the back, in the center, or across the low back
• It can be radiating into your hips, buttocks, thighs, to your knees or into your calves
• There may be numbness, tingling, pins and needles sensations

All of these characteristics are clues as to the type of pain (inflammatory, mechanical, neuropathic) and where it may be coming from. Something to keep in mind is that where the pain is located is not always where it’s coming from. Pain, especially when neuropathic, can be radiating somewhere else away from its source.

Causes of pain can be:

• Muscle strain / tightness
• Joint or ligament sprain
• Disc inflammation / bulge
• Nerve inflammation / irritation 
• Arthritis (osteoarthritis, ankylosing spondylitis, etc.)
• Scoliosis / postural 
• Central sensitization (some component of a stronger pain pathway etc)

As an example… for disc issues bending forward might make the pain worse. For a muscle strain, it might feel like a good stretch. Depending on the joint issue, it might feel relieving. 

So what can I do about my low back pain? 

Now that you know not all low back pain is created equal, what should you do?

Depending on the severity of your pain, you may see your physician (now Telehealth). Based on your symptoms they may decide to:

• send you for imaging, just in case (many may suggest this if your pain is not resolving with the next 2 steps)
• prescribe anti-inflammatories and muscle relaxers (sometimes, this may not be enough to resolve the issue)
• refer you to physiotherapy! 

In Ontario, unless specified by your insurance company, you do not have to have a Doctor’s referral to see a Physio.

And if in the times of COVID-19 you’re not keen on visiting the doctor’s office as your first option, you can always consult with a Physiotherapist virtually! 

While Telerehab (virtual physiotherapy), is a little different than an in-clinic assessment and treatment, the same principles apply: 

• we will ask you to perform certain movements in different positions to test what you can and cannot do
• we provide education on assessment findings and self-management, as well as answer any questions you may have
• we prescribe an exercise program specific to what you are experiencing and gradually progressing it as you improve 
• we provide education on self-maintenance and prevention, especially if this is a recurrent issue 

What do I need for a Telerehab session?

The silver lining is, depending on how much your back is bothering you, you can be assessed without leaving the house! And if your home workspace is also a problem, our physios can take a look virtually!

What you need:

• Internet connection (you may even use your phone’s hot spot if the WiFi at home is not always reliable) 
• Camera (preferably mobile, as in the case of a smartphone, table, or laptop)
• Comfortable clothing to move around in
• Some open space where you can stand, turn, bend, maybe squat
• A place you can comfortably sit and also lie on (it can be a bed, the couch, the floor)

Do I still need imaging to diagnose my back pain?

Imaging (e.g. X-rays, MRI) is not always necessary to diagnose low back pain issues, as different methods of imaging have their limitations. E.g. X-rays only see bone, so they cannot diagnose a muscle strain. 

In a lot of people over the age of 30, imaging may find evidence of osteoarthritis or Degenerative Disc Disease (DDD). However, studies show that degenerative changes in the spine are just as likely to be found in someone with no symptoms, and these changes cannot predict future development of pain. 

That’s not to say that osteoarthritis or DDD cannot be a source of pain, but in the absence of any other testing, their presence is not a definitive cause. 

Of course, imaging does have a role. If you’re already seeing a health care practitioner for your back pain (or even other issues) but not improving, imaging can be done to rule out any underlying causes. It can diagnose more specific diseases such as Ankylosis Spondylitis, or conditions such as spondylolisthesis. It can give a more accurate scoliosis diagnosis. And in the rare cases that it’s the source of pain, imaging can be used to detect cancer. 

Do I need medication from my Doctor to get better?

Not necessarily!

In minor acute cases, medication and rest may resolve the pain. But if this is a recurrent issue, or the rest and medication are not enough, you will likely be referred to physiotherapy.

Sometimes people do well with only physiotherapy, without needing the medication. Other times, if the pain is too severe (i.e. more acute) anti-inflammatories and/or muscle relaxers can certainly help ease the intensity of the symptoms, improving sleep quality and making it easier to progress through the physiotherapy exercises. The goal is that medication is not something you end up relying on!

Medications do not speed up tissue healing, nor do they make your muscles or other tissues stronger or more robust. Those are all things that are within YOUR control. In terms of Physiotherapy low back pain, the things that we can help you with in virtual physical therapy sessions are the tings that will help you the most and have the longest lasting effect!

Our team at Palermo Physiotherapy and Wellness Centre is happy to help you. We are able to provide virtual physiotherapy sessions to anyone in Ontario. Most insurance companies now allow this type of physio treatment from physiotherapists, but we advise you to check on your individual case.

Contact us to book in or see how our Physiotherapists can help you virtually, with your low back pain.