Disclaimer: Back pain is complex but rarely harmful. However, the following section is meant for educational purposes only and not to diagnose any conditions. You should always consult a medical professional before attempting treatments when experiencing pain.
Our goal is to help you understand why your back hurts. Back pain can be divided into two main types, each needing different treatments: acute and chronic.
In the context of back pain, "acute" means that the pain started recently and usually lasts less than 3 months. It often comes on suddenly and is typically related to an injury or a specific incident.
Most people with acute lower back pain recover well. About 40% are pain-free after 6 weeks, and about 70% are pain-free within a year. However, acute back pain often comes back, with up to 84% experiencing it again within a year. Physical therapy can help reduce current pain and teach you how to manage it better in the future.
Acute low back pain often results from a muscle strain or ligament sprain. Strains and sprains occur when your back muscles and/or ligaments are overstretched during heavy lifting or quick, sudden movements. The pain is usually diffuse and may or may not spread to the buttock area. It worsens with movement and feels better with rest.
Initially, treatment involves rest and avoiding activities that caused the strain. Applying ice (never directly on the skin) can reduce the pain and swelling, as can using over-the-counter pain relievers like ibuprofen or acetaminophen. Gentle stretching and strengthening exercises can help once the initial pain subsides.
The intervertebral disc in the lower back has several vital roles. It helps the spine absorb shock, maintain flexibility, and stabilize under heavy loads. The disc has two main parts: an outer layer of tough cartilage and an inner gel-like layer. The outer layer is strong and resists various forces, while the inner layer is mostly water, helping to support weight and pressure.
A herniated disc happens when the soft inner part of a spinal disc pushes out from its usual space, which may lead to nerve compression. Acute disc herniations usually occur during heavy lifting or twisting motions.
The pain from an acute disc herniation can be extreme, often feeling like a sharp or burning sensation. Unlike regular back pain, the pain from a herniated disc can spread to your legs. If nerve compression is present, leg pain is usually greater than back pain and may worsen when sitting. This type of pain can radiate to the hip and/or anterior thigh, as well as below the knee.
Conservative management of acute disc herniations can be very effective. Initial treatment begins with rest and avoiding activities that aggravate the pain. Physical therapy can help by implementing gentle exercises to reduce the pain and improve mobility.
The good news for those with a herniated or bulging disc is that these conditions often improve on their own over time. Most of this healing happens within the first year, starting as early as 2 to 3 months, but full recovery can take up to 40 months.
Chronic back pain is defined as pain that is persistent or recurrent and lasts for longer than 3 months (it could be on and off). Even though chronic back pain can be long-lasting, the good news is that about 40% of people recover completely within a year. This should give hope to those who’ve had back pain for a while, showing that many do get better with time.
Here are some causes of chronic back pain:
Disc degeneration, a natural part of aging, doesn't always lead to pain. As people age, the discs in their spine lose water content, making them less flexible and shorter. This is a normal process and should not cause undue worry. It can sometimes lead to conditions like facet arthritis and spinal narrowing but not always to pain.
Normal age changes of the discs start as early as the 20s, with about 37% of people affected, and the chance of it increases with age. By age 50, about 88% of people have some degree of disc structural changes in their lower back. By age 80, almost everyone has it. However, many people with degenerated discs don't experience any pain, and finding it on an X-ray/MRI doesn't necessarily mean the person will have pain.
Even though disc structural changes are common, people with back pain are more likely to have them than those without pain. Research shows that individuals under 50 with back pain are more than twice as likely to have disc structural changes. However, the link between degeneration and pain is less evident in older adults, as degeneration is almost universal in this age group.
If pain due to disc structural changes is present, the evidence is clear that exercise should be the mainstay of physical therapy treatment. At Plyogenix, we believe exercise should always be accompanied by reassurance and encouragement to resume regular activities.
Research shows that both bulging and herniated discs (think of it as a bump or swelling on your intervertebral disc) are common in people who do not have any symptoms. Bulging discs appear in 30% of people in their 20s and increase to 84% in their 80s. Similarly, disc herniations are found in 29% of people in their 20s, increasing to 43% by their 80s.
If you have been diagnosed with herniated or bulging disc in your back and you are experiencing pain, one piece of very encouraging news is that these conditions often improve on their own over time. Most of this healing happens within the first year, starting as early as 2 to 3 months, but full recovery can take up to 40 months.
In some cases, even if the disc has healed, symptoms might still persist. That's where physical therapy comes in. Through personalized exercises and treatments, physical therapy can significantly reduce pain, enhance mobility, and restore your confidence. The goal should always be to improve your quality of life, helping you get back to the activities you love with less discomfort and greater ease.
Sciatica is a term used to describe pain that starts in the buttock and travels down the leg along the path of the nerves from the lumbar spine. It's also called lumbar radiculopathy. Most commonly, sciatica is caused by a herniated disc in the lower back, where the disc presses on a nerve root. Recent evidence shows that a combination of pressure, inflammation, and immune system responses causes the symptoms related to sciatica.
The first step in treating sciatica is conservative care. This includes learning about sciatica and encouragement to stay active.
For those dealing with sciatica, the importance of staying active cannot be overstated. Doctors recommend maintaining physical activity and advise against bed rest. Research suggests that physical therapy may provide slightly better relief from leg pain than staying active alone in the short term, but both methods are equally beneficial. In the long run, both staying active and undergoing physical therapy offer similar advantages. If leg pain is your primary concern, physical therapy may be a better option for you than just staying active.
Mechanical thoracic spine pain, often called non-specific thoracic pain, is a condition in which pain arises from structures in the thoracic spine, such as the joints, muscles, or ligaments. It does not involve underlying severe conditions like infections or tumors but rather results from biomechanical issues within the thoracic spine itself.
Pain is typically experienced in the middle back area and can sometimes radiate to the chest or upper back. Activities that can worsen the pain include prolonged sitting or standing, bending, lifting, and twisting motions. Pain might also be aggravated by sustained uncomfortable posture or repetitive activities that strain the thoracic region.
Treatments for this type of back pain include exercises to improve the endurance of the postural muscles supporting the thoracic spine and increase the range of motion of the joints in the t-spine. Techniques may include manual therapy, stretching, and strengthening exercises.
Most patients with mechanical thoracic spine pain experience significant improvement with conservative treatment. Ongoing physical therapy and postural education can help reduce the chance of recurrence and manage symptoms effectively.
To be able to tell with more certainty what is causing your back pain, we recommend an assessment from a licensed medical professional or book a call with one of our licensed Doctors of Physical Therapy.
