Having back pain can be one of the most debilitating conditions. While no injury is fun to have, back pain seems to interfere the most with our daily lives. I have personally suffered with back pain as well. In my mid-twenties before I went to physical therapy graduate school I had severe sciatica pain. I was diagnosed with disc herniation and piriformis syndrome. That pain thankfully went away before I entered the doctorate program which involves a lot of sitting in class. Since that time, I have had SI Joint issues which have limited my ability to fully participate in athletic activities. I am now able to do most of what I want to do, and still working at increasing my performance without back pain. Throughout this process in my own life, I have explored different reasons for my own pain and sought out ways to get rid of it.
Why do I have back pain?
Back pain can be one of the most elusive conditions to figure out exactly what is causing the pain. Depending on who you go to, and what training they have received, you will get a different answer. You see a primary care doctor and they diagnose you with lumbar sprain/strain. You see a chiropractor and they show you an X-ray of the alignment issues in your spine. You see an orthopedic surgeon and they show you an MRI of a disc herniation and possibly some stenosis. You hear about acupuncture from your friend and give it a try. You also might seek out some massage therapy for some temporary relief. So which one is right? The funny thing is that they all might be right. You could have an alignment issue with your SI Joint which is causing adverse strain on your musculature and disc. This has now developed into a muscle strain and disc which is strained. Your muscles hurt and your nervous system is sending pain signals as well.
What does physical therapy do?
So how are we different than all the other treatments? Well, as I stated earlier, people are going to answer you according to the training they have received. We see through the goggles of a physical therapist. What does that mean for me? I am always seeking answers to 2 questions when I evaluate someone.
1) What tissue is causing the pain?
2) What is causing the stress to that tissue which has led to it breaking down to the point of pain?
To answer the first question, we can use imaging studies and reports from your physicians. We can perform special tests. We listen to your symptom description and see what tissue type these reports match up with.
To answer the second question, we have to take a broader look at your body. What is going on in your hips, thoracic spine, feet, and more? Why is your back region being strained to the point that you are now having pain? These questions can be answered by looking at your posture and movement. As a physical therapist, I consider myself a movement expert. My job is to see how your body is moving and determine how we can get it to move in the way it was designed.
Answering the first question is important, because it helps guide us in how to treat it. Tissue types respond differently than others and require a specific approach. However, I believe the second question is even more important to answer. In some ways it doesn't matter what tissue is irritated, as long as we can get rid of the stressors which are causing it to be irritated. Because of this, a huge part of my focus in treatment is on the biomechanics of movement. I want to see what isn't moving correctly and give you tools to use to get it moving correctly again.
So whether you have a back strain, disc herniation, SI Joint disorder, or other back condition, our focus will be the same. Find the tissue at fault and find the reason for the stress. This all works well for mechanical reasons for back pain. What we haven't discussed are the myriad of other conditions which could be causing back pain. Back pain can come from internal organ issues, auto-immune disorders, psychological strain, nervous system issues, and more. In addition, your back condition may have deteriorated to the point of needing surgical intervention. While I believe this should be the absolute last resort for an individual, it is sometime the saving procedure for a patient. I know I am limited in my ability to help people with their back pain. I have the tools of a physical therapist. It is for this reason I am thankful for other health care professionals such as surgeons, MD's, DO's, chiropractors, massage therapists, and others who devote their efforts at relieving the pain in patients with the tools they have been given.